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05/31/2000 09:09 FAX 14024714429 NEBRASKA UCC Z 004 /004 <br />Or <br />rrara m <br />M romus <br />illlll IIIII 11111 II111 llill illll 111i 1111 <br />9900058638 Pas <br />17I11SIMONS MARJORIE R <br />Filed 06/3112000 08 16 AM <br />200004420 <br />Notice of State Tax Lien <br />PLEASE DO NOT WRITE IN THIS SPACE <br />This Notice or State Tax Ilea is hsued by the Nebraska Department of <br />Revenue for unpaid taxes pursuant to the revenue laws of the state of <br />Nebraska. Notke is hereby given that taxes including penalties and <br />interest, which are shown below, are due from the taxpayer specified <br />below sad remain unpaid after demand These taxes constitute a lien in <br />the county for real and personal property belonging; to the taxpayer or <br />herml1m scoulred. <br />Nebraska IdenliFcetlon Number <br />39533522 <br />Lien Filed With <br />WReglawofDeed' 11 CountyC *k <br />Social Seclrity or Fadaral I.D. Number <br />545 -98 -6160 <br />Spouse's Sochi Security Number <br />Lien Serial Number <br />992110519 <br />Uen Type <br />0 QVW 0 °ont numm ❑ correasd <br />Date of Lien <br />03-22-2000 <br />Courtly <br />HALL <br />BUSINESS NAME AND LOCATION ADDRESS <br />TAXPAYER NAME AND MAILING ADDRESS <br />Busirmse Name <br />Name <br />MARJORIE R FITZSIMONS <br />Street Address <br />Street or Other Maikg Address <br />2830 NORTHWEST AVE <br />CRY Sate Zip Code <br />Crty state Zip coda <br />GRAND ISLAND NE 68803 <br />Cs6wory <br />NrsT�er <br />Tax Period <br />Amount of Tax <br />Penalty <br />Interest <br />Additions <br />AsaeaamentDus Balance of <br />202.2 <br />7 3 7 <br />3801.57 <br />Return to: <br />STATE OF NEBRASKA <br />DEPARTMENT OF REVENUE <br />1811 WEST 2ND ST STE 460 <br />GRAND ISLAND NE 88803 <br />TOTAL <br />S 3801.57 <br />1 hereby certify that the Nebraska Department cf Revenue has complied with the revenue laws al the State of Nebraska in the detsrmnason <br />of fm amount shown to be due, and the taxpayer hae failed to pay the amount due after demand. tf this Nodoe of State Tax Lien ic an etdension of <br />ar, eff ' e Ilan, it serves to oorsinue the priority of ft state's interest in the afloctad property of the taxpayer. <br />sign w -mv 4VA�3 5Z 0?� <br />here tae Date / Telephone No. <br />r <br />Authaa r Tkla jr Date/ <br />NEBRASKA DEPAR M&t OF REVENUE'. Whita and Goldenrod Copies TAXPAYER - Pink Copy COUNTY OFFICE - Canary Copy <br />p,,.,e. i.o5 .1 pq 448474 Rev. 10.95 Suparsad1 4494 -1~ R.v. 5.95 C <br />