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This Notice of State Tax Lien is issued by the Nebraska <br />Revenue for unpaid taxes pursuant to the revenue laws <br />Nebraska. Notice is hereby given that taxes including penalties <br />Interest, which are shown below, are due from the taxpayer <br />below and remain unpaid after demand. These taxes constitute <br />in the county for real and personal property belonging <br />or hereafter acquired. <br />' <br />Department of <br />of the state of <br />and <br />specified <br />a Ilen <br />to the taxpayer <br />PLEASE DO NOT WRITE IN THIS SPACE <br />Nebraska Identification Number <br />36458430 <br />Federal Identification Number <br />Lien Serial Number <br />940210007 <br />Lien Fled With <br />IAReg of Deeds DCounly Cleric <br />Sodal Security Number <br />XXX -XX -9476 <br />Spouse's Sodal Security Number <br />Date of Llen <br />05/03/1994 <br />Lien Type <br />County <br />HALL <br />• Orkhnal ®Continuatlon I Corrsotad <br />BUSINESS NAME AND LOCATION ADDRESS <br />TAXPAYER NAME AND MAILING ADDRESS <br />"flax <br />LARSON/THOMAS <br />517E11THST <br />SPENCER IA 51301 <br />Category <br />Number <br />Tax Period <br />, <br />Date of <br />, Assessment <br />Amount of Tax <br />Penalty <br />Interest <br />- <br />Additions <br />Balance of <br />Assessment Due <br />22 <br />1990 <br />04/08/1983 <br />399.00 <br />324.75 <br />391.14 <br />.00 <br />1,114.89 <br />TOTAL <br />of the State of Nebraska in the determination <br />$ 1,114.89 <br />of the <br />1 hereby cab that the Nebraska Department of Revenue has complied with the revenue laws <br />Aug. 13. 2013 1:26PM NE Secretary of State — UCC No. 0433 P. 2 <br />201306551 <br />Nebraska Department of <br />Revenue Agent <br />sign <br />here • Revenue Supervisor <br />D tS/1 . <br />Ya Sec ai 51a4 Bann a Gale - UCC SCOM <br />111111 1111 ill <br />9913720903 -9 Pes: 3 <br />LrR SON THOMAS <br />Filed: 96/13/2013 01:22 PM <br />REVENUE NOTICE OF STATE TAX LIEN <br />www.revanue.ne.pcV U 0 - 3 <br />C • x .00 40 I i 5 <br />amount Mown to be due, and I he 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 intend in the affected property of the taxpayer. <br />(402)471 -5928 <br />1 *Mors) Number <br />4.494.1974 Rev, 22002 Sup rades 4494 -1971 Rot <br />