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Tax <br />— <br />. . <br />Category <br />Tax Period <br />Date of <br />Amount of Tax <br />Penalty <br />I rlrest <br />Additions <br />Balance of <br />Number <br />Assessment <br />Assessment Due <br />04/03/2013 WED 14:29 FAX 402 471 4429 UCC SECRETARY OF STATE <br />City <br />O � <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 a lien <br />in the county for real and personal property belonging to the taxpayer <br />or hereafter acquired. <br />Nebraska Identification Number Federal Identification Number <br />Lien Serial Number <br />/ <br />Date of Lien. <br />Business Name <br />Street Address <br />01 <br />21 <br />10625224 <br />03/25/2013 <br />BUSINESS NAME AND LOCATION ADDRESS <br />12/31/2011 <br />01/01/2011 <br />03/31/2011 <br />uthonzed ignature <br />01/25/2013 <br />01/25/2013 <br />3'crtbrazkr e't��srtrner,t'o! <br />REVENUE NOTICE OF STATE TAX LIEN <br />Lien Filed With <br />Lien Type <br />201302681 <br />Register of Deeds OCounty Clerk <br />Original 0Continuation ['Corrected <br />State zip Code <br />449.17 <br />222.37 <br />Name <br />Hall <br />CHRISTINA Q, pcHQCKE <br />Street or Other Mailing AW4rgss . <br />1604 N. GRA(p ISLAND AVE. <br />City <br />90.00 <br />33.36 <br />NE Sec of Skaie John A Gala - UCC STL <br />9913712169 -1 Itgs : 1 <br />SCHOCKE CHRIST NA G. <br />Filed: 04/03t2013 10:42 AM <br />PLEASE DO NOT WRITE IN THIS SPACE <br />Social Security Number <br />XX -XX -0994 <br />Cou <br />HALL <br />TAXPAYER. NAME AND MAILING ADDRESS <br />State <br />Nn ISI AtJll NF <br />-43 <br />0.13 <br />lI002/002 <br />Spouse's Social Security Number <br />Zip Code <br />563.60 <br />275.86 <br />TOTAL $ 839.46 <br />I hereby certify that the Nebraska Department of Revenue has complied with the revenue laws oflhj. St to cif Nebraska in the determination of the <br />amount shown to be due, and he taxpayer has fai - to pay the amount due after demand. If this Not i of State Tax Lien is an extension of an <br />effective lien, it sery : o = • ntinue the priority • state's interest in the affected property of the Ia ay =r. <br />e - 4 _ _, 'Revenue Agent � o . 3' 402 471 -6067 <br />s • repay -r's Signatu / Title <br />here 8 4 X16 4' /i 4 1_,,,____ %r. Senior Revenue Agent <br />Title <br />Telephone Number <br />Date <br />4-494 1/4 13ev. 212002 Supersedes 4. 494 -19'4 Rev. 10 -1995 <br />