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06/11/2012 MON 14:58 FAX 402 471 4429 UCC SECRETAR% OF 5TATE ~~~ Hall <br />� �, <br />PIEASE REl'URN T0: <br />NEBRASKA DEPT OF REVENUE <br />1313 FARNAM-ON-THE-MALL <br />OMAHA NE 68102-1871 <br />2012046� <br />I�ooz�oo2 <br />� . <br />Nebraska Depaitx�e�t of <br />R�IfEN�l:E NOTICE OF STATE TAX LIEN <br />�vtrv;;. �e�e � � e. n e:gav <br />This Notice of State Tax Lien �is issued by the Nebraska Department of <br />Revenue for u�pafd taxes pursuant to the revenue laws of the state of <br />Nebraska. Notice is hereby given that taxes inciuding penalties and <br />interest� which are shown beiow, are due from the ta�cpayer specified <br />below and remain unpaid after demand. These taxes constitute a lien <br />in the counfiy for real a�d persona! property betonging to the ta�cpayer <br />or hereafter acquired. <br />36211702 <br />11284048 <br />�RegisterotDceds []CountyClerkl XXX-XX-8382 <br />Q6/08/2012 �]Original []Con6nuatian []Corr� HALL <br />BUSINESS NAME ANO LOCATION ADDRESS TAXPAYER NAME AND MAIIING <br />MICHELLE R HARTFORD <br />921 N WALNUT <br />GRAND ISLAND NE 68801 <br />Cetegory Tax Pe�od Date oT <br />Number Assessmei <br />22 2008 04/02/2011 <br />Amount of 7ax <br />1,163.30 <br />Penalt�r Interest <br />58.17 183.26 <br />1,404. <br />TOTAI - � {$ �.aoa.73 <br />I hereby ceRifj� that the Nebraska Dep�artment of Revenue has compfied with the revenue laws nt me s�ate m rvenrasKa u� u�e oe�ermmaaon or u�e <br />amount sho�vn to be due, and the taxpayer has failed to �y the amaur� due after demand. If this NoGice of State Tax Lien is an exbension of an <br />effedive lien, it serves to �nue the priority of the srate's interest in the affected property oF the ta�aye�. <br />'► Revenue Senior Agent � a (308)632-1205 <br />sign Pre�a ' ig Title Date Telep�� er <br />here ► Revenue Supervisor <br />rized S re Title D e <br />4�4941974 Rav. 2-20U2 Supersedes M494-1974 Rev.1at995 <br />Additions I Balance of <br />Assessment Due <br />� <br />