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10/25/2001 14:36 FAX 14024714429 NEBRASKA UCC <br />r <br />Irq* <br />200110859 <br />Q002/002 <br />STL <br />Ii �i I :55 AM <br />Please Return Original Copy to the <br />Nebraska Dept. of Revenue at 200 <br />South Silber, North Platte, NE <br />69101 <br />Ir Notice of State Tax Lien <br />JAWSOM <br />01evenuue PLEASE DO NOT WRITE IN TEAS SPACE <br />This Notice of State Tax Lies is issued by the Nebraska Department of <br />Revenue for unpaid taxes pursuant to the revenue laws of he st al d <br />Nebraska. Notice is hereby given that taxes including pe <br />Interest, which are shown below, are due Prom the taxpayer specified <br />below and remain unpaid after demand. Tbe a taxes to stitute taxpayer In <br />the county for real and personal property e <br />s +. <br />hereafter acquired. <br />ects <br />Security Dr Federal I.D. Number Spouses S, ecur , . , • - -• <br />Nebraska Idendilcation Number <br />Lien Fled With <br />Lien <br />RO*W 01 Decide ❑ County as* <br />514 -78 -3804 <br />99595652 <br />een <br />Data of Lien County <br />Hall <br />Ugn Serial Number <br />®�T � C0"" "1fld0" � cmeoted 10 -23 -01 <br />011870200 <br />TAXPAYER NAME AND MAILING ADDRESS <br />BUSINESS NAtAE AND LOCATION ADDRESS <br />Name <br />Business Name <br />Clyde Stout <br />Street or other Mailing Address <br />SreetAddress <br />522 East Division <br />CRY state <br />zip <br />City state <br />Grand Island NE <br />zip Code <br />68801 <br />Tax <br />Daft Amount of Tax Penalty Interest Additions <br />Belance of <br />AssementDue <br />as <br />Category Tax Period <br />A <br />Number <br />05 -21 -01 981.00 <br />257.75 233.52 <br />1,472.27 <br />22 1998 <br />TOTAL $ 1,472.27 <br />,,wady tha Nebraska Deparmren�Rwenuahp=Pfi with the reverwe laws of the State of Nebraska in tde detarmirotion <br />and the 1a7tpaY� ttas iaiied to pay the arnamtt due attar demand. It this Notice of Sta s Tax Usn is an extension of <br />M e arts 10 r t}ie state's interact in the aHectad Property 01 the taxpayer. <br />an d servay tie c0ntmue the prix ity <br />NEBRASKA DEI <br />j n -23_m can& 5a5 =8294 <br />dt�prt� Aft _.____• Date Telephone No. <br />rye 10 -23 -01 y <br />Revenue S ruiner Date }� 1 <br />rile �a TAXPAYER - Pink COPY COUNTY OFF ICE -Canary Copy <br />While and Goldenrod Cop' 4:094.74 wY. terse supereema 4-494-74 nw 5'95 <br />