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This Notice of Slate Tax Llen Is Issued by the Nebraska Department of <br />Revenue for unpaid taxes pursuant to the revenue laws of the elate of <br />Nebraska. Notice is hereby given that taxes Including penalties and <br />Interest, which are shown below, are due from the taxpayer epecHled <br />below end 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 ac . cued. <br />PLEASE DO NOT WRITE IN THIS SPACE <br />-.r as a • -n .: ,on s , r <br />40996905 <br />•era •e 1 rce on <br />umber <br />Lien Serial Number <br />1750071 <br />ban Hod Mb Ismail ia Se Number <br />© Regimen on Deese IJCouny Cleric! XXx XX -1483 <br />Spouse's Soria! Security Number <br />Dare or Len <br />10131/2000 <br />Lien Type <br />Donginal © Continuation 'Corrected <br />County <br />Hall <br />I BUSINESS NAME AND LOCATION ADDRESS <br />TAXPAYER NAME AND MAILING ADDRESS <br />Business Nellie <br />Name <br />Behrens <br />Address <br />nee Of Other Medina Manse <br />2f21 Bellwood Dr 95 <br />ti p we <br />city 4 on <br />Grand Island NE 68801 <br />Tea <br />Catrgory <br />Number <br />Tat Period <br />Dap of <br />Aeaeaamenl <br />Arltount 01 Tax <br />. Penalty <br />Interest <br />Additlona <br />Balance of <br />Ae Setfl4 MDUD <br />22 <br />1992 <br />05/07/2000 <br />775.00 <br />193.75 <br />482.53 <br />1,451.28 <br />22 <br />1993 <br />05/07/2000 <br />865.DD <br />216,25 <br />478.02 <br />1,55917 <br />22 <br />1994 <br />05/07/2000 <br />792.00 <br />198,00 <br />377.69 <br />1,367.69 <br />22 <br />06/17/1905 <br />05/07/2000 <br />477 -26 <br />119.32 <br />184.52 <br />781.10 <br />TOTAL <br />5 5,159.34 <br />I r,...h... -..n <br />164 Ike Naeruro Ornaoment o <br />Revenue nee ea relied with the revenue laws a the Blare at Nebraska N the eeIerminellon of the <br />May. 10. 2016 3:09PM NE 'Secretary :f state — UCC N., 6426 F. 9 <br />ut,t- or image rage 1. of 2 <br />201602885 GPI \ U7r1M <br />4• <br />Please Return 7o: <br />Nebraska Department of Revenue <br />4500 Ave 1 PO Box 1500 <br />Scottsbluff NE 69363 -1500 <br />REVENUE <br />amount shaem to be . e. end the taxpeyAs as fai rd to pay the amount due alter ,amend. II this Natjw ei Stale Tax uen o an eatermon of in <br />the etete'a Interest In On affected property of the taxpayer. <br />0 4 <br />here @ <br />AY' Dri=ed <br />effadlee uen, h so <br />e the <br />06/0112010 <br />Title Dale <br />Revenue Supervisor _ <br />Revenue Agent <br />Tile <br />'i'i'iig <br />� f <br />ur <br />Per <br />r 011 :49 nn <br />Date <br />4-404 Ras 2-2002 ausarrrdea e-4eu 1074 Rev. 10..995 <br />SEE ATTACHMENTS <br />a <br />NOTICE OF STATE TAX LIEN <br />308 632 -1200 <br />Telephone Number <br />06/0112010 <br />https:// www. nebraska. gov /sos/ucc /uccsearch.cgi7docnum= 9910629148 -9 4/18/2016 <br />