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08/10/2012 FRI 14:47 FAX 4p2 471 4429 UCC SECRETARY OF 5TATE ��� �all <br />- '� <br />� <br />20120664G <br />�002/004 <br />ua sn <br />�S: , <br />RND T <br />AT7 <br />� �9+:aabrsske t��*ib�ear�at +ot <br />��� NOTICE OF STATE TAX LIEN <br />VvwV4a�iV�'i�Y:Ri. n11r. &Y►V <br />. <br />PLEASE DO A10T WRITE IN THIS SPACE <br />This Notice of State Tax Lien is issued by the Nebreska Department of <br />Revenue for unpaid taxes pursuant to the revenue laws of the state of <br />Nebraska. Notice is hereby given that taxes including penalties and <br />interest, which are shown betow� are due from the taxpayer speciffed <br />below and remain unpaid after demand. These Eaxes canstitute a lien <br />in the county for real and personal property belonging to the taxpayer <br />or hereafter acauired. <br />8239665 <br />39-1964386 <br />f/�, �`��'"'�'� QRegister of Deeds �County Clerk <br />� of Lien Lien Type County <br />08/06/2012 QX Original �Continuation []Corrected Hall <br />BUSINESS NAME AND LOCATION ADDRESS TAXPAY�R NAME AND MAIL{NG ADDRESS <br />Category <br />Numher <br />01 <br />01 <br />7ax Pariod I Date of <br />03/31/2012 � 06/01/Z092 <br />05/3 � /2012 + 08/01 /2012 <br />Amount of Tax <br />10,481.42 <br />8,253.70 <br />Grand Island Liquor Mart and Tobacco Row L,I..C. <br />et or Other Mailing Addresa <br />710 N. Die�s Ave. Suite L. <br />State Zip Code <br />Grand Island Ne. 68803 <br />Penalty Interest Additfons Balance of <br />Assessment D <br />1,048.14 194.30 11,723.86 <br />367.22 I 68.74 <br />TOTAL <br />8,689.66 <br />$ 20,413.52 <br />����,Q� ��u, �,�a� u,� ,.,o����na �cparun�n� vr rcevenue nas compuea wrcn rne revenue iaws ot tne state ot NearasKa �n the aetarminac►on of the <br />amount shown to be d, nd the taxpayer has failed to pay tha amount due after demand. If this Notic@ of State Tax Lien is an extension of an <br />effective lien, it se s continue the prio ' the state's interest in the affected property of the taxpayer. <br />e � Revenue Agenf �f � 0 402 471 <br />sign Preparer's Si nature Title Date " Telephone Number <br />here e �(O( � Senior Revenue Agent • �' j/ Z <br />A horized Signature Ti�e Date <br />4�494-7974 Rev. 2-2�d2 Supersedes 4�94-1974 Rev.10-1995 <br />� <br />I <br />