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05/30/2012 WSD 15:45 FAX 402 471 4429 UCC SECRETARY OF STATE ~~~ 8a11 <br />� <br />2012U�3�� <br />�•—�.� ,�.,�- <br />�4bFAracks �ayr1Ttr�Rtl�Yt �yf <br />����� <br />WWW.! tWI nts�. isi.00�/ <br />This Notice of State Tax Lien is issued by the Nebraska Department of <br />Revenue for unpaid taxes pursuant to the revenue laws of the state of <br />Nebraska. Notice is hereby giv�n that taxes Including penalties and <br />interest, which are shown below, are due from the taxpayer specified <br />below and rematn unpaid afte� demand. These taxes constitute a lien <br />in the county for real and personal property belonging to the taxpayer <br />or hereafter acauired. <br />10170227 <br />/ <br />OX Register of Oeeds �County <br />05/23/2012 I QOriglna! �Contlnuation <br />BUSINESS NAME AND LOCATION ADDRESS <br />Category Tauc Period Date of <br />Number AssessmeM <br />01 04/01/2010 03/14/2011 <br />09/30/2010 <br />XXX-XX-7479 <br />NOTICE OF STATE TAX LIEN <br />�Corrected I Hall <br />, TAXPAYER NAME AND MAILING ADDRESS <br />Ciark E. Bey <br />Street or Other Mailing <br />221 E 'D' St. <br />Zip Code City <br />� Hastings <br />Amount of Tax Penally <br />435.02 96.00 <br />�003/003 <br />-----._...� r.a:co q17 <br />Ne. <br />Interest ! Additlons <br />37.40 <br />TOTAL <br />68901 <br />Balance of <br />�essment Due <br />568.42 <br />$ 568.42 <br />� uc�GUy �:c�u�y u�a� �no �ve����sRa uepaRmen� vr rcevenue nes compllea wltt� tne revenue laws of the 5tate of Nebraska in the determinaUon of the <br />amount shown to be due, and the tanpayer has failed to pay the amount due after demand. If this Notice of State Tan Lien is an extension of an <br />effective lien, it se continue the priori he state's interest in the affected property of the taxpa ec <br />e � Revenue Agent �° �y/ pL� 402 471-6067 <br />sign Prep ets Signature T�le ate Telephone Number <br />here e , Senior Revenue Agent 5�, �-�� <br />Au Signat e Title Date '�—� <br />. 4-084-1974 Rev. 2-2002 Supetsedes q Rev. 10-1995 <br />