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12!07!2001 16:25 FAX 14024714429 NEBRASKA UCC <br />20011`602 <br />Ir <br />netireelu <br />d"wbn*rtt <br />of revenue <br />fa003i003 <br />Ne s...+ e4.1i. - ucC 1srt. <br />111111111111111111 11 <br />9901181825 -5 Pgs. 1 <br />ELL ISON THOMAS R <br />Filed: 1210712001 01:24 PM <br />Notice of State Tax Lien <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 />hereafter acquired. <br />PLEASE DO NOT WRITE IN THIS SPACE <br />Nebraska Idenlificstion Number Lten Filed With Social Security or Federal I.D. Number I Spouse's Social Security Numoer <br />6317995 [5a Re ilster of Deeds ❑ County Clerk 506-70-9266 <br />Lien Serial Number lien Type , Date of Lien County <br />1 <br />01/12/315 ® orgies C] Cortinuation C] Corrected 11/30/01 HALL <br />BUSINESS NAME AND LOCATION ADDRESS TAXPAYER NAME AND MAILING ADDRESS <br />Business Name I Name <br />THOMAS R ELLISON <br />Street Address <br />Street or Other Mailing Address <br />311 W 15TH ST <br />City State Zip Code <br />City State Zip Code <br />GRAND ISLAND NE 68801 <br />Tax <br />Cateegqoory <br />Number <br />Tax Period <br />Date of <br />Amount of Tax <br />Penalty <br />Interest <br />Addition* <br />Belance of <br />Asas�rnsrA Due <br />01 <br />3/31/01 <br />11/30/01 <br />154.00 <br />32.25 <br />6.81 <br />193.06 <br />01 <br />17/01/01 <br />6/30/01 <br />11/30/01 <br />154.00 <br />30.80 <br />4.63 <br />199.43 <br />- <br />01 <br />9/30/01 <br />11/30/01 <br />154.00 <br />25.00 <br />1.14 <br />180.14 <br />Please return to: <br />STATE OF NEBRASKA <br />DEPARTMENT OF R -VENUE <br />1811 WEST ?" ST STE 460 <br />GRAND ISLAND NE 68803 <br />TOTAL <br />$ 562.63 <br />I hereby osrtlly that the Nabraska Departrrtent of Revenue has complied with the revenue laws of the State o1 Nebraska in the oetermtnauon <br />of the amount shown to be due, and the taxpayer has failed to pay the amaxd due after demand. If this Notice of State Tax Lien is an extension of <br />an epectiva lien, ft serves to continue the priority of the state's it ter t in the affected propertiii of the taxpayer. <br />sign <br />here Preer'sSignature a Date Telephone <br />par <br />r(Authorized SWanW Title Dat <br />NEBRASKA DEPARTMENT OF REVENUE - White and Goldenrod Copies TAXPAYER - Pink Copy COUNTY OFFICE Cana 'Copy <br />ry a; <br />p.vw! o. S� iron 4454.74 Hev. 10.95 SuPef5ade9 4494-74 11111 . 5 -015 � <br />