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201304128
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5/24/2013 8:47:14 AM
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5/24/2013 8:27:45 AM
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DEEDS
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201304128
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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 15:38 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 Identification Number <br />Lien Serial Number <br />Business Name <br />Street Address <br />City <br />10290958 <br />/ /3.3 irC- ' <br />Date of Lien <br />04/30/2013 <br />01 09/01/2011 02/02/2012 <br />10/30/2011 <br />01 <br />01 <br />01 <br />01 <br />01 <br />Lien Filed With <br />Lien Type <br />El <br />BUSINESS NAME AND LOCATION ADDRESS <br />2013(4128 <br />�va�br.ekA Diti ulrn.snt of <br />REVENUE NOTICE OF STATE TAX LIEN <br />wvvvv..rwvwnuss..*b. b s:: <br />Register of Deeds I (County Clerk <br />Original DContinuation Corrected <br />State Zip Code <br />0.00 <br />Federal Identification Number <br />Name <br />s -. <br />Revenue Agent <br />sign / Pre arer's ignature Title <br />here Mr4A4A., Revenue Senior Agent <br />uthonzed Signature Title <br />.4y■ <br />PLEASE DO NOT WRITE IN THIS SPACE <br />Social Security Number <br />XXX -XX -9614 <br />County <br />Hall <br />TAXPAYER NAME AND MAILING ADDRESS <br />DONN & VICTORIA HICKOK <br />Street or Other Mailing Address <br />PO BOX 133 <br />City <br />CAIRO <br />177.22 <br />65.39 <br />Hall 0009 /011 <br />NE See of asaw - - -- <br />9913715755 -8 Pes: 1 <br />HICKOK DONN <br />Filed: 05/23/2013 02:51 PM <br />Spouse's Social Security Number <br />XXX -XX -0022 <br />State <br />NE. <br />Zip Code <br />68824 <br />11/01/2011 0 <br />11/30/2011 01/25/2012 <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 />04/01/2012 <br />04/30/2012 <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 />62.11 <br />66.28 <br />36.45 <br />25.00 <br />23.08 <br />26.08 <br />2.60 <br />14.17 <br />0.00 <br />160.00 <br />20.00 <br />0.22 <br />TOTAL <br />242.61 <br />23.08 <br />248.19 <br />68.88 <br />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, and the taxpayer has failed to pay the amount due after demand. If his Notice of State Tax Lien is an extension of an <br />effective lien, it se o continue the p; f(r of the state's interest in the affected property of he taxpayer. <br />402 471 -6067 <br />Telephone Number <br />Date <br />4-494 -1974 Rev. 2 -2002 Supersedes 4.494 -1974 Rev. 10-1995 <br />
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