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11120!2001 17:11 FAX 14024714429 NEBRASKA UCC 1a004/004 i 200112055 Post I 7 Pm tr Notice of State Tax Lien nebra.ke department 01 revenue PLEASE DO NOT WRITE IN THIS SPACE Please returnto: STATE OF NEBRASKA DEPARTMENT OF REVENUE 1811 WEST 2ND ST STE 460 GRAND ISLAND NE 68803 INDIVIDUAL INCOME TAX SOC. SEC. N0. 506681983 NEBR. .IDENT. N0. 13162780 SPOUSE SOC. SEC, NO. 3 TAXABLE YEAR 1998 LIEN NO. 0 2500337 COUNTY LL— HENRY A ROY DATE OF NOTICE 0 7/2001 507 NEST 14TH ST DATE OF ASSESS14ENT 05/03/2001 GRAND .ISLAND NE 68801 THIS NOTICE OF STATE TAX LIEN IS ISSUED BY THE NEBRASKA DEPARTMENT OF REVENUE FOR INDIVIDUAL INCOME TAX PURSUANT TO THE REVENUE LAWS OF THE STATE OF NEBRASKA. NOTICE IS HERESY GIVEN THAT INDIVIDUAL INCOME TAXES INCLUDING PENALTIES AND INTEREST, WHICH ARE SHOWN BELOW ARE DUE FROM THE TAXPAYER SPECIFIED ABOVE AND REMAIN UNPAID AFTER DEMAND. THESE TAXES CONSTITUTE A LIEN IN THE COUNTY FOR PROPERTY BELONGING TO THE TAXPAYER OR HEREAFTER ACQUIRED, AMOUNT OF TAX ■ . . . . . . . . . . . . . . . . . 645-00 PENALTY . . . . . . . . . . . . . . . . . . . . . 161.25 INTEREST (COMPUTED TO 09/07/7001) ■ a • • • • a • 139.32 TOTAL AMOUNT DUE . . . . . . . . . . . . . . . . 945.57 I .HEREBY CERTIFY THAT THE NEBRASKA DEPARTMENT OF REVENUE HAS COMPLIED WITH THE REVENUE LAWS OF THE STATE OF NEBRASKA IN THE DETERMINATION OF THE AMOUNT SHOWN TO BE DUE* AND THE TAXPAYER HAS FAILED TO PAY THE AMOUNT DUE AFTER DEMAND. IF THIS NOTICE CF STATE TAX LIED IS AN EXTENSION OF AN EFFECTIVE LIEN IT SERVES TO CONTINUE THE PRIORITY OF THE STATEIS INTEREST IN THE AFFECTED PROPERTY OF THE TAXPAYER* as PREPARER'S SIGNAT RE TITLE DATE /TELEPHONE . /� . :.. ..:::'Z if A i. tYr Si177'� .. .: /.1...... . AUTH= SIG RE TITLE DATE NEBRASKA DEPARTMENT OF REVENUE— White and Canary Copies TAXPAYER —Pink Copy Printed rrilh soy ink on recycled paper 7.145.1979 Rev. 2.2000 SUperaadea 7.145 -1979 Rev. 1: -1995. ti