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05/19/2004 09:40 FAX 14024714429 <br />Or <br />NEBRASKA UCC <br />20040000 <br />U003/003 <br />N! Soe of Sioko • IICC stow <br />I ... mon Nis 111111 will MEN low low. <br />MM334425 -8 Poo: 1 <br />HAMMRIGH VERNON D <br />Filed: 05/111/2004 04:25 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 <br />in the county for real and personal property belonging to the taxpayer <br />or hereafter acquired. <br />PLEASE DO NOT WRITE IN THIS SPACE <br />;tr q5— jo 5 t <br />Nebraska Identification Number Lien Fled With Social Security Number '5pouse °s-Sveiai-SetQtlfy Number <br />16993489 X❑ Register of Deeds [:] County Clerk 504 -64 -9276 <br />Lien Serial Number Lien Type Date of Lien County <br />942380107 []Original XZ Continuation ❑ Corrected 1 07/03/1995 414 <br />BUSINESS NAME AND LOCATION ADDRESS TAXPAYER NAME AND MAILING ADDRESS <br />Business Name Name <br />VERNON D HAMMRICH <br />Street Address Street or Other Mailing Address <br />RR 3 BOX 176 <br />City State Zip Code City State Zip Code <br />CHILLICOTHE MO 64601 <br />Tax <br />Category <br />Tax Period <br />I <br />Date of <br />I <br />Amount of Tax <br />I <br />Penalty <br />I <br />Interest <br />I <br />Additions <br />I <br />Balance of <br />Number <br />Assessment <br />Assessment Due <br />I hereby certify that the Nebraska Department of Revenue has complied with the revenue laws of the State of Nebraska in the , <br />determination of the amount shown to be due, and the taxpayer has failed to pay the amount due after demand. If this Notice of State _ F� <br />Tax Lien is extension of an effective lien, it serves to continue the priority of the state's interest in the affected property of the taxpayer. <br />Revenue Agent �3—Q 402 471- 5835G' <br />sign Prepare Is Signature 7 Title Date Telephone Number <br />here _ �friio�e ,ice „�i” --1�� <br />Authorized Signatdre Title Date <br />