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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 />05/23/2013 THU 15:37 FAX 402 471 4429 UCC SECRETARY OF STATE Hall 2006/011 <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 <br />10290958 <br />Lien Serial Number <br />/33 /, -7 <br />Date of Lien <br />04/30/2013 <br />Business Name <br />Street Address <br />City <br />01 <br />01 <br />01 <br />01 <br />01 <br />01 <br />sign <br />here <br />09/01/2011 <br />10/30/2011 <br />02/02/2012 <br />j�'continue the prior <br />-7-z.04‘r/ <br />rep rer's Si nature <br />uthorized Signature <br />Lien Filed With <br />1E3 <br />Lien Type <br />BUSINESS NAME AND LOCATION ADDRESS <br />State Zip Code <br />atutet- <br />201304125 <br />1 1116, ‘" <br />Nt•br41%kif OPparTMOnt <br />REVENUE <br />WWW.,11,e10 or...W.01ov <br />Register of Deeds County Clerk <br />Original DContinuation OCorrected <br />0.00 <br />Title <br />Title <br />Federal Identification Number <br />Name <br />Revenue Agent <br />177.22 <br />Revenue Senior Ajent <br />NOTICE OF STATE TAX LIEN <br />PLEASE DO NOT WRITE IN THIS SPACE <br />Social Security Number <br />County <br />Hall <br />DAVID T. HICKOK <br />Street or Other Mailing Address <br />1678 WILD FLOWE <br />City <br />TWIN FALLS <br />65.39 <br />he state's interest in the affected property of the taxpayer. <br />HICKOK DAVID T. <br />Filed 05/23/2013 0239 PM <br />TOTAL <br />Spouse's Social Security Number <br />TAXPAYER NAME AND MAILING ADDRESS <br />State <br />ID. <br />Zip Code <br />83301 <br />11/01/2011 <br />11/30/2011 <br />12/01/2011 <br />12/31/2011 <br />01/01/2012 <br />02/29/2012 <br />03/01/2012 <br />03/31/2012 <br />01/25/2012 <br />02/02/2012 <br />05/01/2012 <br />05/22/2012 <br />06/01/2012 <br />0.00 <br />0.00 <br />0.00 <br />0.00 <br />0.00 <br />0.00 <br />62.11 <br />66.28 <br />36.45 <br />25.00 <br />23.08 <br />26.08 <br />2.60 <br />14.17 <br />0.22 <br />242,61 <br />23.08 <br />160.00 248.19 <br />68.88' <br />20.00 70.62 <br />25.22 <br />678.60 <br />I hereby certify that the Nebraska Department of Revenue has complied with the revenue laws of the State of Nebraska in the determination of the <br />amount shown to be due nd he taxpayer has ailed to pay the amount due after demand. If his Notice of State Tax Lien is an extension of an <br />effective lien. it se <br />402 471-6067 <br />age 4? <br />Dat6 Telephone Number <br />/3 <br />Date <br />4-494-1974 Rev. 2-2002 Supersedes 4-494-1974 Rev. 10-1995 <br />