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Tax <br />Category <br />Tax Period <br />Date of <br />Amount of Tax <br />Penalty <br />Interest <br />Additions <br />Balance of <br />Number <br />Assessment <br />Assessment Due <br />05/16/2013 THU 15:12 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 a lien <br />in the county for real and personal property belonging to the taxpayer <br />or hereafter acquired. <br />Nebraska Identrfication Number <br />9065628 <br />Lien Serial Number <br />Date of Lien <br />Business Name <br />Street Address <br />City <br />01 <br />sign <br />here gi <br />133 a8'a ty <br />05/09/2013 <br />01 i' i L V 1 �- 08/23/2011 <br />12/31/2010 <br />Lien Filed <br />El <br />BUSINESS NAME AND LOCATION ADDRESS <br />I .brysk. Oepann+ *flt at <br />REVENUE NOTICE OF STATE TAX LIEN <br />Register of Deeds 13Count Clerk <br />Gen Type <br />Original ['Continuation Corrected <br />State Zip Code <br />3,555.00 <br />Title <br />201303918 <br />Federal Number <br />Name <br />Social Security Number <br />xxx -xx -8945 <br />County <br />HALL <br />LEE E ECHTENKAMP <br />'Street or Other - Mailing Address <br />PO BOX 186 <br />City <br />PLEASE DO NOT WRITE IN THIS SPACE <br />TAXPAYER NAME AND MAILING ADDRESS <br />1/1/2011- 08/07/2012 <br />12/31/2011 <br />h <br />4,445.00 <br />fi <br />red <br />889.00 <br />257.81 <br />h <br />TOTAL <br />ws of the State of Nebraska <br />711.00 <br />Revenue Senior Agent <br />Title <br />Revenue Senior Agent <br />381.51 <br />Date <br />Hall <br />NE See of Sato <br />9913715219 -1 P9s: 1 <br />E E <br />ECHTENKAMP LE <br />Filed: 05/1612013 09:16 AM <br />pouse's Social Security Number <br />State <br />NE <br />Zip Code <br />68824 <br />4,647.51 <br />5,591.81 <br />$ 10,239.32 <br />t <br />hereby certify that t e Nebraska Department oRevenue as comp with a revenue in the determination <br />amount shown to be due, and the taxpayer has failed to pay the amount due after demand. If this Notice of State Tax Lien is an extension of an <br />effective lien, it serves to continue the priority of the state's interest in the affected property of the taxpayer. <br />4-494 -1974 Rev, 2 -2002 Supersedes 4494 -1974 Rev. 10-1995 <br />lI002 /004 <br />of the <br />402 471 -5709 <br />Telephope Nupnber <br />S S <br />Date <br />