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Tax <br />Category <br />Number <br />Tex Period <br />Date of <br />Assessment <br />Amount of Tax <br />Penalty <br />Interest <br />Additions <br />balance of - J ! <br />Assessment Due <br />• Jan,29 2414 3:28PM NE Secretary of State — UCC <br />Street Address <br />01 <br />sign <br />here <br />01/23/2014 <br />BUSINESS NAME AND LOCATION ADDRESS <br />Husiness Name <br />01/01/2013 06/03/2013 <br />03/31/2013 <br />01 06/30/2013 <br />A f..i .. <br />• r <br />geature <br />201400543 <br />4 1b.. k. Capp.•T+P ern! e1 <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 Idenfifiration Number <br />8923027 <br />Lien Serial Number <br />f/ yLle <br />Date <br />REVENUE NOTICE OF STATE TAX LIEN <br />.%. w. R a <br />Lien Filed With <br />® Register of Deeds [J County Clerk <br />Zip Code <br />0.00 <br />Title <br />rederal Identification Number <br />Lien Type <br />Original DContinuatlon Corrected <br />Name <br />Kathleen C. Davidson <br />Street or Other Mailing Address <br />226 W. Stolley Park Rd <br />Clly <br />Grand Island <br />04/01/2013 <br />the <br />08/01/2013 <br />0.00 <br />25,00 <br />0.03 <br />TOTAL <br />0.00 <br />Revenue Senior Agent <br />V E LF of Sle Q 3091 al• - P. 2/3 <br />9814729743 -0 Ns: 1 <br />QaYIDSON KATHLEEN C. <br />Filed: 0112912014 a1:21 PM <br />• <br />PLEASE DO NOT WRITE IN THIS SPACE <br />Social Security umber <br />XXX -XX -8675 <br />County <br />HaU <br />0.05 <br />pcuse's •ciel eau <br />TAXPAYER NAME AND MAILING ADDRESS <br />stale <br />Ne. <br />Date <br /># - 1474 Rev. 2-2002 &+ omae; 4-001-1e74 Hay. 10-1096 <br />lY <br />Zip Code <br />68801 <br />0.05 <br />25.03 <br />$ 25.08 <br />I hereby minty that Nebraska Department of Revenue has complied with the revenue laws of the Slate of Nebraska In the determinetbn of the <br />amount shown to be due, and the taxpayer has failed to pay the amount eve after demand. If this Notice of Stale Tax Lien is an extension of an <br />effective lien, it servge4 ZOntinue the pr of the slate's interest Jr the affected property of the taxpayer. <br />Revenue Agent <br />Tile <br />um• ar <br />402 471.6067, <br />