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12/11/2001 18:14 FAX 14024714429 NEBRASKA LCC Ia003 /003 <br />l <br />1 � <br />U <br />Or <br />In-, ka <br />arrpsrueent <br />of avenue <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, wbicb are shown below, are due from the taxpayer specified <br />below and remain unpaid after demand. These taxes constitute a lies to <br />the county for real and personal property belonging to the taxpayer or <br />hereafter acquired. <br />Social security or Federal I.D. Number Spouse's 5M <br />8577196 LXRegister of Deeds Li UY raerx 1 5 7— 5 0— 5 31 4 <br />Lien Serial Number Lien TVs Date of Lien County <br />01 /12/316 K] Original ❑ Condnue ion ❑Corrected 12-05-01 HALL <br />BUSINESS NAME AND LOCATION ADDRESS TAXPAYER NAME AND MAILINf3 ADDRESS <br />easiness Nano MELODY ROE <br />STOCKMEN'S CAFE <br />Street Address S e4tQ corer MgtA1MAddress <br />613 E 4TH ll 161'1 <br />City state Zap Code City Stilts Zip Code <br />r_6IIrt1 <br />PLEASE DO NOT WRITE IN THIS SPACE <br />200112747 <br />STL <br />III III, <br />01 <br />T <br />05 -08 -01 <br />0.0 <br />62.00 <br />0.7 <br />66 <br />01 <br />Tax Period <br />Date of <br />Amount o} Tax <br />Penalty <br />Interest <br />Additions <br />ps Balance aertof <br />DYV <br />Category <br />09 -01 -01 - <br />09 -30 -01 <br />A�as1711" <br />593.2 <br />59.33 <br />6.0 <br />8 <br />Numborr <br />1404.90 <br />01 <br />03 -01 -01 - <br />03 -31 -01 <br />05 -08 -01 <br />0.0 <br />62.00 <br />0.7 <br />66 <br />01 <br />06 -01 -01 - <br />06 -30 -01 <br />12 -04 -01 <br />603.4 <br />60.34 <br />19.7 <br />r683.56 <br />01 <br />09 -01 -01 - <br />09 -30 -01 <br />12 -04 -01 <br />593.2 <br />59.33 <br />6.0 <br />8 <br />— Ploasa rcturnio: <br />STATE OF NEBRASKA <br />— DEPART dEIN7 OF REVENUE <br />1811 WEST 2ND ST STE 460 <br />— GRAND ISLAND NE 68803 <br />1404.90 <br />TOTAL $ <br />I heteby certify that the Nebraska Department of Revenue has complied with the revenue laws of the State of Nebraska in the determination <br />of the amount shorn to be due, and tie taxpayer has failed to pay the amount due after demand. M this Notice of Stale Tex Lien is an extension of <br />an of e*e fien, it serves continue the priority of the state's iMe in the aRected pre only o s taxpayer. 1 <br />sign /J ) o �3- <br />here asps sSigiia w Date Telep No. <br />orite SI Tide <br />NEB SKA 6EPARTmw OF REVEW White and Goldenrod Copies TAXPAYER - Pink Copy 4.A"74 RNTY OS OFFICE canary Rem e•es <br />rnree an r..yav r+•c• J1 <br />