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201307664
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9/19/2013 2:37:29 PM
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9/19/2013 2:20:28 PM
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201307664
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Tax <br />Category <br />Tax Period <br />Data of <br />Amount of Tax <br />Penalty <br />Interest <br />Additions <br />Balance of <br />Number <br />Assessment <br />Assessment Due <br />Sep. 18. 2013 2 :56PM NE Secretary of State — UCC <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 Ideniliicabon Number <br />11240393 <br />Lien Serial Number <br />l /3 e / tvg <br />Date of Lien <br />Business Name <br />Street Address <br />City <br />21 <br />21 <br />sign <br />here <br />09/13/2013 <br />Lien Flied Wkh <br />Lien Type <br />a <br />BUSINESS NAME AND LOCATION ADDRESS <br />07/28/2013 <br />03/31/2012 <br />Original OContinuation UCorrected <br />Stare Zip Code <br />20130 766 <br />Nybvwako °Woo: .srtt U <br />REVENUE NOTICE OF STATE TAX LIEN <br />..�.�... <br />Register of Deeds ElCouny Clerk <br />275.00 <br />The <br />Federal Identification Number <br />26- 3482260 <br />Social Security Number <br />XXX-XX-2922 <br />Name <br />CHRIS GREEN <br />County <br />HALL <br />Street or Other Mailing Address <br />10437 CR 270 <br />City <br />CARL JUNCTION <br />96.25 <br />15.01 <br />i <br />i <br />Revenue Agent 94.7,Ap/ <br />'nos Date <br />Revenue Senior Agent <br />No.0960 P. 3 <br />NE Sec aF Slate John A Gale - UCC STS <br />9813722937-2 Pie: 1 <br />GREEN CHRIS <br />Flied: 09/10/2013 02:10 PM <br />PLEASE DO NOT WRITE IN THIS SPACE <br />Spouse's Social Security Number <br />TAXPAYER NAME AND MAILING ADDRESS <br />State <br />MO. <br />Zip Code <br />64834 <br />04/01/2012 <br />06/30/2012 <br />07/28/2013 <br />265.00 <br />d <br />92.75 <br />11.14 <br />TOTAL <br />I <br />386.26 <br />368.89 <br />$ 755.15 <br />of <br />I hereby certify that the Nebraska Department evenue has complied with the revenue laws of the Slate of Nebraska I n the determination of the <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 en <br />effective lien, it sere Minuet the pr of the state's Interest In the affected property of the taxpayer. <br />Dale <br />4499 - 1974 Rev. 24002 Gupereede. 4 1-1974 Rev. 104995 <br />402 471 -6067 <br />Telephone Number <br />
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