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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 />Asessiwi.nt <br />Aeesesraent Due <br />City <br />Jan.13 2014 3 :06PM NE Secretary of State — UCC <br />/ /VF(7 0/ <br />Dale Lien <br />ausmeaa Name <br />Street Address <br />01 10/0111012 11/0912013 <br />12/31/2012 <br />21 <br />sign <br />here <br />umber <br />12/18/2013 <br />BUSINESS NAME AND LOCATION ADDRESS <br />thorized Signature <br />State <br />201400236 <br />tbY.4k :IR - h.'f ' I �! <br />REVENUE NOTICE OF STATE TAX LIEN <br />.rww _ • -•er A V., .'r. to _ <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. NotlCe 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 f=ederal entlfrIbn Number <br />8617829 47 - 0841728 <br />Lien Filed With <br />®Register of Deeds ❑County Clads <br />Lien Type <br />IXIOriginal []Continuation <br />Zp Code <br />325.00 <br />Name <br />Cry <br />Revenue Agent <br />Title <br />['Corrected <br />HUSKER PLUMBING & DRAIN, INC. <br />Street or Other Malin Address <br />3821 ARCH AVENUE <br />GRAND ISLAND <br />10101/2012 02/11/2013 <br />12/31/2012 <br />oT <br />664.30 <br />33.22 <br />17.52 <br />TOTAL <br />65,00 <br />Title <br />Revenue Senior Agent <br />Social Security Number <br />County <br />HALL <br />8.87 <br />No.2808 P. 2 <br />hE !.0 aF 11.4. J.hn A del• - UCC ;IL <br />9914728612 -6 Pia: 1 <br />Filed! el L414 69:43 • <br />PLEASE DO NOT WRITE IN THIS SPACE <br />TAXPAYER NAME AND MAILING ADDRESS <br />Side <br />NE <br />s Social curry Number <br />$ 1,113.81 <br />1 hereby certify thal the Nebraska Department Revenue has complied with the revenue laws of the State or Nebraska in the determination piths <br />amount shown to be and the texpeyet has failed to pay the amount due lifter demand. If this Notice of State Tax Len is an extension or an <br />effect1ve Nen, It serer to continue the prioylgpf the state's interest in the affected properly or the taxpayer. <br />of/ /a / 7 <br />Date Telephone Number , <br />Date <br />4.494 -1974 Rev. 2-2002 Sups ■ac 4494 -1104 Ray. 10-1996 <br />Zip Code <br />68803 <br />398.87 <br />715.04 <br />402 471.6067 <br />t/ <br />