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V <br />09/11/2001 11:02 FAX 14024714429 NEBRASKA UCC IM002 /002 <br />Or <br />dperNent <br />of revelm <br />I <br />200109191 <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 b hereby given that taxes Indudhng penalties and <br />Interest, which are shown below, are due lt'om Ike taxpayer specified <br />below and remain unpaid after demand. These taxes constitute a lien is <br />the county for real and personal property belonging to the taxpayer or <br />hereafter acauired. <br />Nebraska IdeMfiation Number <br />8037884 <br />Uen Riled Yft <br />Q Register of Deeds ❑ County clerk <br />taooial Sea^ or Federal I.D. Number <br />.512-46-2257- <br />Spouse's Social Seourity Number <br />Usn Swul Number <br />01/09/375 <br />Lien Type <br />®OVna ❑ COMMiation ❑ Conected <br />Date of Lien <br />9/5/01 <br />County <br />HALL <br />BUSINESS NAME AND LOCATION ADDRESS <br />TAXPAYER NAME AND MAILING ADDRESS <br />Sisiness Name <br />Name <br />DANIEL M DEPOY <br />Street Address <br />Street or Other fdailirg Address <br />703 W 14TH <br />Ghy Sao Zip Cods <br />CRY stem Zip Code <br />GRAND ISLAND NE 68801 <br />sx <br />Catspory <br />Nw� <br />TexParlod <br />b <br />Amount of Tax <br />Penalty <br />Inter <br />AddMions <br />ABalaenn Due <br />01 <br />— i <br />12/31/00 <br />4/4/01 <br />131.49 <br />27.12 <br />21.40 <br />180.01 <br />P "o return to: <br />STATE OF NEBRASKA <br />--- DEPARTMENT OF REVENUE <br />1811 WEST 2ND ST STE 460 <br />— GRAND ISLAND NE 68803 <br />_ <br />TOTAL <br />$ 180.01 <br />I hereby certify that tlto Nebraska Dgmrbnert of Revenue has compliod with the revanue laws of the State of Nebraska In the dalerminadon <br />of the amount shown to be due, and the taxpayer has failed to pay the amount due after demand. If this Notice of State Tax Uen is an extension of <br />an effective lien, It serves to oorrtinue the VNft of the state's interest In e affected property of Unayer. <br />sign <br />here r'teparera3igrraturs rate once — Tel .ptan. o. <br />Title <br />NEBRASKA DEPARVERF4F REVEN E •White and Goldenrod Copies TAXPAYER •Pink Copy COUNTY OFFICE - Canary COPY <br />pare M nryOtl plow 4.49474 Rev. io-se sutwsedm 4-414-74 P— e-06 <br />