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05/il/2012 FRI 15:17 FAX 402 471 4429 UCC SSCRETARY OF STATB �y� aall <br />� � , <br />�003/003 <br />1 S!e!e Jehn R Gele - UCC STL <br />1836-5 Pss: 1 <br />LRRRY J <br />06/ 11 /2012 08:49 HMI <br />2 0120379� <br />. . <br />... <br />�: <br />Netira�ka=Depar�ment of <br />��v��u.E <br />www.revenire.ne.gov <br />NOTIGE OF STATE TAX LIEN <br />This Notice of State Tax Lien ts issued by the IVebraska Department of <br />Revenue for unpaid t�axes pursuant to the revenue laws of the state of , <br />Nebraska. Notice ls hereby given that taxes including penalties and <br />interest, which are shown below, are due from the taxpaye� speci�ed <br />��� ��� -- -�- ��---below and r�main unpaid afterdemand. These tax� constltute a lien <br />in the county for real and personal property betonging to t�e taxpayer <br />or hereafter ac uired. <br />Nebras Iden6ficatwn Number Federal Identifirdtlon Number <br />97264679 <br />Uen Seria Number Lien ded Wlth Sa�al Sewrity Number <br />11279727 �Register of Oeeds QCamry Clerk XXX XX <br />Date at Uen Uen Type County <br />05/09/2012 �Orig� ❑�n��� ❑� HALL <br />BUSINESS NNKE AND LOCATION ADDRESS 7AXPAYER NAME AND <br />Category Tex Petlod <br />Number <br />22 2008 <br />2z aaos <br />Oats oE I Amounl of Tax <br />05/26/2Q09 126.00 <br />05/07/2010 68.00 <br />LARRY J HOBSON <br />8750 N SKYPARK RD <br />ST LIBORY NE 68872 <br />Penalty <br />18.30 <br />3.40 <br />Inter�t t Adalaons <br />25.64 <br />7,Q3 <br />189.94 <br />78.43 <br />, <br />i <br />! <br />f: <br />� <br />f; <br />i <br />r <br />',' <br />� <br />�� <br />�• <br />I <br />I � L I I TOTAL I$ 248.3� I <br />I f�ereby c�rtity that the Nebraska Departrne.nt of Revenue has ccmplied with the revenue laws fhe State of Hebraska in the detertnmaHon ot the <br />amour�t shrnm to be due, and tl�e ta�ayer has fiailed to pay the ama.mt due after demand. ff th(s No�ioe of State Tax Lien is an ext�nsion of an <br />effective lien, it rves to continue the riority aF the state's inter�st in the affected propedy of U�e taxpay�. <br />Revenue Agent 9� (402�71-5789 <br />s ign P�epar s S'sgnat�ae �Ue e elephone Number <br />here ► Revenue Supervisor S. �l , 1 <br />A " ed Signad,re Title Date <br />4�484-1874 Rex 2-2002 Suparse0es 4494-1974 Aee 1a1886 <br />ADDRESS <br />Balance ot <br />�� <br />