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04115/2001 09:49 FAX 14024714429 NEBRASKA UCC [a 003/003 <br />f� <br />Or <br />rwbrsaMs <br />dapartrna t / <br />d MOMS <br />lllll�lllllllllllllllrll f DO <br />Pga pooHE54 6 ill101 <br />Filed 04 /18iZppp <br />- - - 1 09 13 AM <br />200103398 <br />Notice of State Tax Lien <br />PLEASE DO NOT WRITE IN THIS SPACE <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 specilled <br />below and remain unpaid after demand. These taxes constitate a Den in <br />the county for real and personal property belonging to the taxpayer or <br />hereafter acquired. <br />Nebraska IderelAoation Number <br />22862854 <br />Uen Rled With <br />E] Register of Deeds ❑ county Clerk <br />Social Security or Federal I. D. Number <br />1505-78-8992 <br />Spouse's Social Security Number <br />Uen Serial Number <br />981700090 <br />Uen Type <br />Z] 0"nel ❑ Continuation ❑ Coaeceee <br />Date of ten <br />04-06-01 <br />County <br />HALL <br />BUSINESS NAME AND LOCATION ADDRESS <br />TAXPAYER NAME AND MAILING ADDRESS <br />Busiress Name <br />Name <br />DOUGLAS A POLCHES <br />sweet Afton <br />Sreet or Other Melling address <br />818 W 3RD ST <br />City State Zip Code <br />City State Zip Code <br />GRAND ISLAND NE 68801 <br />Nurnory <br />TaxPerlod <br />Assessment <br />Amount of Tax <br />penalty <br />Irttaroat <br />Additions <br />Assesornent Due <br />22 <br />1994 <br />04 -12 -98 <br />536.00 <br />134.00 <br />288.38 <br />953.38 <br />- Please return to: <br />STATE OF NEBRASKA <br />- DEPARTMENT OF REVENUE <br />1811 WEST 2ND ST STE 460 <br />- GRAND ISLAND NE 68803 <br />[ I <br />-- <br />TOTAL <br />t WOW Wnly that 410 Nebraska 0eparenant of Revenue has compiled with the revenue laws all the State of Nebraska in the determingon <br />d the amount shown be due; and the taxpayer has tented 10 Day the MOM due alter demand. It this Nance of State Tax Lien is an edension of <br />an effective Tien, it ee to nue the prkuity of the ante's interest in the affected property Of the taxpayer. <br />Sign I ��sa� c�38s -l�G7� <br />here w Sigmture Tile Date Telephone No. <br />NEBRASKA DEPARTMENT REVENUE - Me and Goldenrod Copies TAXPAYER - Pink Copy COUNTY OFFICE - Canary Copy <br />"( <br />61 °9 -wbd aeon 4-494.74 Ray. 10.95 supwwan 4. 404.74 aey. 5-e5 <br />