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— <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 />PG <br />NO sec of Items JOM R bald . UCC s7L ►— <br />1 11111111 1 1 IIIII <br />9913728107 - 7 .P9s: 1 <br />BURSON SANDRA L <br />Filed; 11/19/2013 12:39 PA <br />Nebraska Idemifeation Number <br />31919529 <br />Federal Identification hunber <br />Lien Serial Number <br />• <br />11324422 <br />Lien Filed With <br />K( Register of Deeds II County Clerk <br />Social Searlty Number 'Spouse's <br />XXX - XX - 2999 <br />Social Security Number <br />Date Gillen <br />11 /12/2013 _ <br />Lien Type <br />7 Original ■ Continuation r Coed <br />County <br />HALL <br />• BUSINESS NAME AND LOCATION ADDRESS <br />• TAXPAYER NAME AND MAILING ADDRESS <br />• • • <br />SANDRA L BURSON . . <br />14425 S BUFFALO RD <br />DONIPHAN NE 68832 <br />- Tax <br />Category <br />Number <br />Tax Period <br />Data of <br />Assessment <br />Amount of Tax <br />Penally <br />Interest <br />Additions <br />Balance of <br />Assessment Due <br />22 <br />2010 <br />09/26/2012 <br />425.00 <br />26.50 <br />r <br />57.13 <br />508.03 <br />TOTAL <br />$ 608.83 <br />I hereby outs that tilt Nebrasic� of Revenue has complied with the revenue Ian; of State of Nebraska in the e n nation of the <br />amount show to be dull) has tailed to oar the amount due after demand_ if this Notice of State Tax Lien fa an AAA/ s of w, <br />Nov. 19. 2013 2:28PM NE Secretary of State — UCC <br />PLEASE RETURN TO: <br />NEBRASKA DEPT OF REVENUE <br />PO BOX 94609 <br />LINCOLN NE 685094609 <br />affective lien, it <br />1 <br />sign <br />here lbw <br />Signature <br />Nebraska Department of <br />www.revenue.ne.gov <br />No. 1949 P. 2 <br />201309159 <br />REVENUE NOTICE OF STATE TAX LIEN <br />state's interest In the affarxed property of the taxpayer. <br />Revenue Agent I 1" / - 1 (308)632 -1210 <br />hue . ate Telephone Number <br />&A • Qeu. A9en + a in fang <br />Title Date <br />4104 -1014 Rev.2.2002 apemen 4.44.1074 Rer, 40.1005 <br />