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05/18/2012 FRI 14:03 FAX 40Z 471 4429 UCC SECRETARY OF STATE -��-� Hall <br />� ' <br />20120399G <br />�looz�oo3 <br />N� ska�Dapartriaent of <br />�IrEI�UE NOTICE OF STATE TAX LIEN <br />wWW.�B„B�ue.R�.�,o� <br />This Notice of State Tax Lien Is issued 6y the Nebraska Department of <br />Revenue for unpaid taxes pursuant to the revenue laws of the state of <br />Nebraska. IVotice is hereby given that taxes including penalties and <br />intecest, which are shown below� are due nam the taxpayer specified <br />below and remai� unpaid after demand. These taxes cons�tute a fien <br />in the county for real and personal propeity belong(�g to the �cpayer <br />or hereafter acquired. <br />26960397 <br />11280733 <br />�Register of Deeds ❑County Clerkl XXX-XX-8744 <br />05/16/2012 �Odginal �Contlnuatlon �Corrected HALL <br />BLlSINESS NAME AND LOCATtON ADDRESS TAXPAYER NAME AN� MAILING ADDRESS <br />DAVID M SANDSTEO <br />2431 DEL MON7E AVE <br />GRAND ISLAND NE 68803 <br />Category Tax Pe�iod Date of <br />Number � Assessmer <br />22 2009 . 05/07/2010 <br />Amount of Tax Penalty <br />830.00 41.50 <br />Interest I Additions <br />86.64 <br />TOTAL <br />958.14 <br />amount shown to be dus, and the taxpayer t�s failed to aay the amaunt due after demand. If this Noflce of State Ta�c Lien is an e�dension of an <br />effective lien, it se res to cntin e priaity of tt� state's irrterest in tl�e aFfected properly of the laxpayer. <br />� , RevenueAgent 5 /6 �G�� (402�t71�043 <br />sign Prepar i hue � Tide Date elephone umber <br />here ► Revenue Supervisor �, l� . i Z <br />rized Signature TiBe Date <br />� 4-484-1974 Rev. 2•Z002 Supersedes d�484-187a Rav.1C1895 <br />� �I�� <br />Balance of <br />Assessment Due <br />858.14 <br />� <br />w <br />I <br />i- <br />