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05/12/2004 11:55 FAX 14024714429 NEBRASKA UCC IM 004 /004 <br />r` <br />Or <br />nebraska <br />department <br />of revenue <br />200404791 <br />Filed: 05/1212004 10:25 PM <br />Notice of State Tax Lien <br />PLEASE DO NOT WRITE IN THIS SPACE <br />INDIVIDUAL INCOME TAX <br />Suva SEC. N'Os 506027497 <br />NEBR- IDEi(T• NOS 31827543 <br />SPOUSE SOC- SEC. N010 508 21112 <br />TAXABLE YEAR 2000 <br />LIES! NO- 012720593 <br />COUNTY HALL SHANE N & WANDA L SMITH <br />DATE OF NOTICE 081101200i 1427 ,NEWCASTLE RD 120 <br />DATE OF ASSESSMENT ' 05/22/2001 GRAND ISLAND NE 68801 <br />THIS NOTICE OF STATE TAX LIEN IS ISSUED BY THE NEBRASKA DEPARTMENT OF <br />REVENUE FOR INDIVIDOAL INCOME TAX PURSUANT TO THE REVENUE LAMS OF THE <br />STATE O;- NEBRASKA- : NOTICE IS HEREBY GIVEN THAT INDIVIDUAL INCDME <br />TAXES INCLUDING PENALTIES AND 'LNTERESTt WH'&CH ARE SHOWN BELOW ARE DUE <br />FROM THE TAXPAYER SPECIFIED ABOVE AND REMAIN UNPAID AFTER DEMANDS <br />THESE TAXES CONSTITUTE A LIES! IN THE COUNTY FOR PROPERTY BELONGING TO <br />THE TAXPAYER OR HEREAFTER ACQUIRED* <br />AMOU(QT OF TAX a 0, . . . a a . a . . . S e • a 706-00 <br />PENALTY . i . is . a, s . . o . . 62 -30 <br />INTEREST (CUMPUTED TO 08/10%2001) . . . . e . . m 24-37 <br />TOTAL AMOUNT DbE e . . . . a e a . . . . . . . . 7$$.67 <br />I HEREBY CERTIFY THAT THE NEBRASKA DEPARTMENT OF REVENUE HAS COMPLIED <br />WITH THE REVENUE LAMS OF THE STATE OF NEBRASKA IN THE DETERMINATION OF <br />THE AM04JNT SHOWN TO' BE DUES AND 'THE TAXPAYER HAS FAILED TO PAY THE <br />AMOUNT DUE AFTER D64AND• IF THIS NOTICE OF STATE TALC LIEN IS AN <br />EXTENSION OF AN EFFtCTIVE LIEN IT SERVES TO CONTINUE THE PRIORITY OF <br />THE STATEOS TNT-REST IN THE AFFECTED PROPERTY OF THE TAXPAYERS <br />Pei <br />a s`f a Samoa.. <br />-as�as � as.s. q Y. * **so <br />* <br />,L s <br />PREPARER' S S is AM It� T E DATE/TELEPHONE <br />F <br />-� • . a e .iaa. . m.11m i.•.a..1..e .mai of m, %"� / <br />T;iORIZ SIGNATURE TITLE DATE i' c � <br />NEBRASKA DEPARTMENT OF REVENUE — White and Canary Copies TAXPAYER — Pink Copy <br />Printed with sov ink on mcycfed paper 7- 145.1979 Rev. 2 -2000 Supersedes 7- 145 -1979 Rev. 10.1995 <br />