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05/12/2004 11:53 FAX 14024714429 <br />Or <br />nebraska <br />department <br />of revenue <br />NEBRASKA UCC <br />200404789 <br />IA 002/004 <br />N[ See of S4a4e - Me STL <br />9904333078 -6 Poe: 1 <br />PALM JULIO E <br />Filed: 06/12/2004 10:25 AM <br />Notice of State Tax Lien <br />PLEASE DO NOT WRITE IN THIS SPACE <br />XWT VIDUAL INCOME TAX <br />Saco SEC* m0a 502576V43 . <br />INEBRo IDENTs, 140. 36954I4-4. <br />SPOUSE SOC. SEC. grin <br />T AXA BLE YEAR - *999 <br />COUNTY HALL UL10 F PAGAN <br />DATE OF NOTICE ! 10 /io /zio!413 11-07 N ANNA ST <br />DATE OF ASSESSMENT 108/26/20003 GRAND ISLAND ME 68803; <br />i <br />c L y� t y��� <br />THIS NOTICE OF STAB TAX LIEN IS ISSUED �� TAE R DEFA' RTP NT OF <br />REVENUE FGR INDIVIDOAL, INCA TAX PURSUANI'T Ta THE REVENUE LAWS Ew THE <br />STATE OF DEBRA. ' . 1 N 1 ICE IS HEREBY GIVEN T40 IMIDIYIDUAL IINCOWE <br />TAXES T,NCLWING PEWLTIE.S ADM INTEREST# WdICH ARE SHUN BELOW AaE DUE <br />AR P T €E A PAYER SPECIFIED AR�OYE AND REMAIN UNPAID- AFTER DERAtM— <br />THESE TAXES CONSTI'Y4-'TE A ' LIE± IN THE ClAiNTY FOR PROPERTIY SELUNG114a TO <br />THE TAXPAYER OR HER TER AC . RED• <br />ANU NT OF TAX % <br />a . <br />PENALTY o s a In a a s s . i 4 • .. . 0 t s 10 a s a . 9ry2r8�5 ly <br />539-Tv- <br />TOTAL A# —KON s_iiiE i • . • a K # f A s • i a . * a ti rZ.- y48'9i55 <br />.1 HERESY .CERTIFY TH^i t T€1z NMRASKA ]DEPARTMENT OF REVS JE HAS COMPLIE -1 <br />4ITH THE RmVENVE LAId OF THE STATE CF REBRAL-rKA xM THE DETTE MINATIUM O <br />THE AROUNT . SHOWN TO I VE VtE, AND TK TAXPAYER m,AS -AILED T-a PAY THE: <br />A90t%T DUE AFTER DEI D4 1F THIS NGTICE OF STATE TAX LIEN iS AN <br />EXTEMSI� OF A Effjt IYE LIEN � SERVES TU C ag��E THE PR.I7TITY OF <br />TAE STATEN S INTEREST 1U Ttl AFFE TEr, PROPERTY 13F TIRE TAXPAYER. <br />�n , <br />a • a s +e s r <br />I <br />NEBRASKA DEPARI <br />Printed with 80V tr* on recycled paper j <br />TITLE <br />sa. •.................a <br />WENT OF REVENUE — White and Canary Copies <br />. sa�aa�- faa. is aa♦ -.: �r �_� <br />v>A ` 41 <br />TAXPAYER -- Pink Copy <br />7- 145 -1979 Rev. 2 -2000 Supersedes 7-145 -1979 Rev. 10.1995 <br />f <br />