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Tax <br />s : <br />Category <br />Number <br />Tax Period <br />Date of <br />Assessment <br />Amount of Tax <br />Penalty <br />Interest <br />f • ' <br />Additions <br />Balance of <br />Assessment Due <br />03/21/2013 THU 15:30 FAX 402 471 4429 UCC SECRETARY OF STATE <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 given that taxes including penalties and <br />interest, which are shown below, are due from the taxpayer specified <br />below and remain unpaid after demand. These taxes constitute alien <br />in the.county for real and personal property belonging to the taxpayer <br />or hereafter acquired. <br />Nebraska Identification Number <br />10734821 <br />Lien Serial Number <br />! /3229%" <br />Date of Lien <br />Business Name <br />Street Address <br />City <br />01 <br />8 <br />sign <br />here <br />03/14/2013 <br />BUSINESS NAME AND LOCATION ADDRESS <br />02/29/2012 05/01/2012 <br />Lien Filed With <br />I hereby certify that the Nebraska Department of Revenue has complied with the revenue laws of OgSjata pf Nebraska in the determination of the <br />amount shown to be due, and he taxpayer has failed to pay the amount due after demand. If this of$tate Tax Lien is an extension of an <br />effective lien, it sery continue the pri of the states interest in the affected propidy of th' " <br />reparer's Signature <br />uthorized Signature <br />'44+t,rar vka 33,..„ 0,....rrt U <br />REVENUE <br />www.MwVe•Nta:er, nfr.!elstir <br />Lien Type <br />Original OContinuation <br />p Code <br />0.00 <br />Title <br />201302224 <br />Federal Identification <br />Re of Deeds OCounty Clerk <br />Name <br />Revenue Agent <br />50.00 <br />Corrected <br />BRIAN K. HO AR ® <br />Street or Other Mailing itts <br />851$ AVEBUR. - CT <br />4-494-1 <br />Senior Revenue Agent <br />Title <br />Hall <br />NOTICE OF STATE TAX LIEN <br />PLEASE DO NOT WRITE IN THIS SPACE <br />l <br />Social Security Number <br />XS.X XX -6339 <br />ty <br />JACKSONVILL <br />unty <br />Hall <br />5 <br />0003/005 <br />NE Sec of Stake John A Cele - C ST <br />1 111 <br />9913711192 -9 Pos. 1 <br />HOWARD BRIAN K. <br />Filed: 03/21/2013 11:35 AM <br />TAXPAR NAME AND MAILING ADDRESS <br />Spouse's Social Security Number <br />State <br />FL. <br />J <br />Date <br />4 Rev. x-2002 Supersedes 4 - 1974 Rev. 10.1995 <br />Zip Code <br />32244 <br />50.95 <br />50.95 <br />402 471 -6067 <br />Telephone Number <br />