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07,131,12001 15:02 FAX 140247429 <br />W <br />E <br />NEBRASKA CCC Z002/003 <br />Mt Stic of Slete U {C 5!L <br />9selt38esE -1 Fgs: 1 <br />RELIABLE TIRE, L.L.C. <br />FtLed: 07/31/2091 02:49 FM <br />Or O <br />mdvasks <br />r <br />department <br />Of IWMW <br />200107583 <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 specified <br />below and remain unpaid after demand. These taxes constitute a lien in <br />the county for real and personal property belonging to the taxpayer or <br />r.a <br />Nebraska Identification Number <br />Lien Filed with II Social Security or Federal I.D. Number <br />Spouse's Social Security Number <br />061068 <br />[ Register of Deeds ❑ County Cleat 1, 47-0812695 <br />Gen Serial Number <br />Uan Type <br />Date of Uen <br />County) J <br />® original C] Continuation E] Corrected <br />07-25-01 <br />1'f Q I <br />BUSINESS NAME AND LOCATION ADDRESS I <br />TAXPAYER NAME AND MAILING ADDRESS <br />Business Name ]NR�LIABLE <br />L.L.C. <br />Street Address <br />j strge o�Qttt W Mail rtQgTgl gRE, <br />tryf 1 Y 9,f8,CK <br />City State zip Code <br />GLENDALE A Z a 85305 Zip Coae <br />Tax <br />Category <br />Tax Period <br />Date of <br />Assessment <br />Amount of Tax <br />Penalty <br />Interest <br />Additions <br />Salanceof <br />Asseesn+eni Due <br />Number <br />05 -01 -00 — <br />6 <br />05 -31 -00 <br />07 -25 -01 <br />426.00 <br />85.20 <br />41.49 <br />552,69.. <br />06 -01 -00 — <br />�6 <br />06 -30 -00 <br />07 -25 -01 <br />426.00 <br />85,201 <br />38.34 <br />549 54 <br />05 -01 -00 — <br />)1 <br />05 -31 -00 <br />11- 0:1 -00 <br />0.00 <br />213.21 <br />64.66 <br />2 7 <br />06 -01 -00 — <br />}1 <br />06 -30 -00 <br />03 -06 -01 <br />1642.741 <br />164.27 <br />1 147 <br />1954-85 <br />Pleats return to: <br />STATE OF NEBRASKA <br />DEPARTN ENT OF REVENUE <br />1811 WEST 2ND ST STE 460 <br />GRAND ISLAND NE 68803 <br />TOTAL <br />$ 3334.96 <br />I hereby certify that the Nebraska Depa.ment of Revenue has oomplied with the revenue laws of the State of Nebraska in the determination <br />of the smount shown to be due, and the taxpayer has failed to pay the amount due after demand. If this Notice of State Tax Lien is an extension of <br />an effective lien, it serves to continue the priority of the state's intergst in the affected prOD" of the taxpayer. <br />1 � <br />sign { , - <br />here Preparar s Signature TAIe _ Date Telephone No. <br />uthor z ra TM oa <br />NEBRASKA DEPARTMENT OF REVE - White and Goldenrod Copies TAXPAYER - Pink Ccpy COUNTY OFFICE - Canary Copy <br />pled a, WW P�k— 4 -49474 qev. 1095 Supersedes 4- 494.74 Pev. 5 -45 <br />