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02/05/2004 17:05 FAX 14024714429 NEBRASKA UCC <br />10006 <br />L' <br />ien Filed With Social Security Number SPOLISe's Social Security Nurnber <br />36458430 XD Register of Deeds [] County C[erk 480 -88 -9476 <br />Lien Seriai Number Lien Type Date of Lien <br />County <br />940210007 1 Orl X Continua n E] Corrected 05/03/1994 Hall <br />BUSINESS NAME AND LOCATION ADDRESS TAXPAYER NAME AND MAILING ADDRESS <br />Business Name Name <br />Thomas Larson <br />Street Address Street or Other Mailing Address <br />City State Zip Code City 517E11thSt <br />State Zip Code <br />Tax <br />Spencer lA 51301 <br />regory Tax Period Date of Amount of Tax Penalty Interest Additions Balance of <br />rmber Assessment <br />Assessment n <br />22 1990 04/06/1993 399.00 324.75 391.14 <br />1,114.89 <br />TOTAL <br />1 hereby certify that the Nebraska Department of Revenue has complied with the revenue laws of the State of Nebraska,in the <br />determination of the amount shown to be due, and the taxpayer has failed to pay the amount due after demand. If this Notice of State <br />Tax Lien's a xtension of an effective lien, it serves to continue the priority of the state's interest in the affected property of the taxpayer. <br />sig;;:uftthoflzed ur evenue Senior A e nt i 308 632 -1200 <br />Itle Date Teleph ne Nu er <br />he� Revenue Agent Supervisor % Q ure Title f! s� P� Date' <br />{ • � ` ATTACHIMPO 1 974 Rev. 2 -2D02 Supersedes 4-494 -1974 Rev. 10 -1995 <br />NE See si 54.4e - nCC SOON <br />L1 <br />20040.151 <br />Please forward to: R <br />R@43 "it- A 2 <br />Nebraska Department of Revenue F <br />LARSON THOMRS <br />4500 Ave I PO Box 1500 <br />Scottsbluff, NE 69363 -1500 <br />orNOTICE O <br />OF STATE TAX LIEN <br />dlttgMrylO{M <br />ofreroa+r <br />This Notice of State Tax Lien is issued by the Nebraska Department of P <br />PLEASE DO NOT WRITE IN THIS SPACE <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 <br />in the county for real and personal property belonging to the taxpayer o <br />or hereafter acquired. <br />Nebraska Identification Number <br />ien Filed With Social Security Number SPOLISe's Social Security Nurnber <br />36458430 XD Register of Deeds [] County C[erk 480 -88 -9476 <br />Lien Seriai Number Lien Type Date of Lien <br />County <br />940210007 1 Orl X Continua n E] Corrected 05/03/1994 Hall <br />BUSINESS NAME AND LOCATION ADDRESS TAXPAYER NAME AND MAILING ADDRESS <br />Business Name Name <br />Thomas Larson <br />Street Address Street or Other Mailing Address <br />City State Zip Code City 517E11thSt <br />State Zip Code <br />Tax <br />Spencer lA 51301 <br />regory Tax Period Date of Amount of Tax Penalty Interest Additions Balance of <br />rmber Assessment <br />Assessment n <br />22 1990 04/06/1993 399.00 324.75 391.14 <br />1,114.89 <br />TOTAL <br />1 hereby certify that the Nebraska Department of Revenue has complied with the revenue laws of the State of Nebraska,in the <br />determination of the amount shown to be due, and the taxpayer has failed to pay the amount due after demand. If this Notice of State <br />Tax Lien's a xtension of an effective lien, it serves to continue the priority of the state's interest in the affected property of the taxpayer. <br />sig;;:uftthoflzed ur evenue Senior A e nt i 308 632 -1200 <br />Itle Date Teleph ne Nu er <br />he� Revenue Agent Supervisor % Q ure Title f! s� P� Date' <br />{ • � ` ATTACHIMPO 1 974 Rev. 2 -2D02 Supersedes 4-494 -1974 Rev. 10 -1995 <br />