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12/19/2001 17:53 FAX 14024714429 NEBRASKA UCC <br />r <br />A <br />Or <br />nebrsaks <br />Ceperhnwrt <br />ee rwanua <br />Q002/003 <br />sn <br />200113131 <br />D <br />2001 02:35 RtM <br />Notice of State Tax Lien <br />PLEASE DO NOT WRITE IN THIS SPACE <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 alter demand. These taxes constitute a lien In <br />the county for real and personal property belonging to the taxpayer or <br />e, sue. ae. o.... -11—A <br />Nebraska Ideriificadon Number <br />27622304 <br />Lien Fled With <br />® Register of Deeds El county Clerk <br />Social Security or Federal I.D. Number <br />508 -96 -0278 <br />Spouse's Social Security Number <br />506-11-6428 <br />Lien Serial Numbed <br />O 1 / 1 2 / 31 8 <br />Lien Type <br />rioinal ❑ Continuation ❑Corrected <br />Date of Uan <br />0 4 - 2 6 - 01 <br />County <br />HALL <br />BUSINESS NAME AND LOCATION ADDRESS <br />TAXPAYER NAME AND MAILING ADDRESS <br />Business Name <br />Name <br />KENNY D & KELLI L KRZ.YCKI <br />Street Address <br />Street or Other Mail' Address <br />2407 WEST JOHN ST <br />city State Zip Code <br />Co State Zip Code <br />GRAND ISLAND NE 68803 <br />Category <br />Number <br />Tax Period <br />Date of <br />Ases04h*11t <br />Amount of Tex <br />Penalty <br />Interest <br />Alidltblte <br />Balance of <br />AsseumentDue <br />22 <br />11999 <br />12 -10 -01 <br />3745. OC <br />300.70 <br />733. 45 <br />4779.15 <br />Ploase returnto: <br />STATE OF NEBRASKA <br />DEPARTMENT OF REVENUE <br />1811 WEST 2N1D ST STE 460 <br />GRAND ISLAND NE 68803 <br />TOTAL <br />$ 4779.15. <br />I hereby cw* that the Nebraska Department Of Revenue has complied with the revenue laws of the state of Nebraska in the determination <br />of the amount shown to a due, and the taxpayer has Wailed to pay the amount due after demand. If this Notice of State Tex Lien's an extension of <br />an effective heA, It to nue the priority of the state's irderest in the affected property otthe taxpayer. . <br />/ i2 1T1cr ' �GG'7z sign <br />here fie/ a Signature Tide - Date Telephone No. <br />z a i <br />A zed si T1ile — Dao <br />NEBRASKA DEPARTMENT OF REVENUE hits and Goldenrod Copies TAXPAYER - Pink Copy COUNTY OFFICE - Canary Copy <br />4-494.74 Rev. V-95 3upeisedea 4 -+974 aay. 5 -95 <br />P'W h,� <br />/,. <br />U <br />