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Tax <br />' <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 />, <br />Assessment Due <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 />9851682 <br />Lien Serial Number <br />Date of Lien <br />Business Name <br />Street Address <br />City <br />sign <br />here <br />r ev. 8. 2013 1:07PM NE Secretary of State — UCC <br />1/32 Ye 73 <br />10/29/2013 <br />21 07 /0112007 12!05/2010 <br />12/31/2007 <br />Signature <br />Lien Type <br />BUSINESS NAME AND LOCATION ADDRESS <br />2413 08929 <br />7 e0e+7n^enl se <br />REVENUE NOTICE OF STATE TAX LIEN <br />www.-e Vwn��., ..•eo <br />Lien Filed With <br />© Re of Deeds DCounty Clerk <br />State Zip Code <br />1,972.33 <br />▪ Original (Continuation D Corrected <br />• <br />Federal Identification Number <br />20- 4702819 <br />Social Security Number <br />XXX -XX -6717 <br />Name <br />Revenue Agent <br />Title <br />TODD FRIESEN <br />County <br />HALL <br />Street or Other Mailing Address <br />1411 W. STOLLEY PARK RD APT. B <br />City State <br />GRAND ISLAND NE <br />239.48 <br />619.29 <br />/1 <br />ME S.c of Skate Jaka. A Gala - UGC STL <br />II <br />it <br />9913725646 -2 Pea: 1 <br />FRIESEN TODD <br />Filed 11/80/2818 18:33 AN <br />No. 1809 P. 2 <br />• <br />PLEASE DO NOT WRITE IN THIS SPACE <br />Spouse's Social Secunly Number <br />TAXPAYER NAME AND MAILING ADDRESS <br />Zip Code <br />68801 <br />has <br />fed with a the <br />l <br />f Ihe-S <br />TOTAL. <br />of Neb <br />in the <br />2,831.10 <br />$ 2,831.10 <br />I hereby r That the Nebraskartment of Revenue comp) revenue taws o late Nebraska determinadon of the <br />amount shown to be due. and the taxpayer has failed to pay the amount due after demand. If this Notice of Stale Tax Lien is an extension of an <br />effective lien. its vE�to continue the polo e' he state's Interest In the affected property of the taxpayer. <br />402 471 -6067 <br />Telephone Number <br />Revenue Senior Agent // ^4.- /J <br />Title Date <br />4.491 -1x14 Rev. 22002 supdsadas 4-494 -1974 Rev. W0-1995 <br />lab <br />