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10/19/2004 13:59 FAX 14024714429 NEBRASKA UCC 0 004/004 <br />209410241 <br />Or <br />nebraska <br />department <br />of revenue <br />SGC• SEC4,400 <br />506904701 <br />UEBR• IDENT• M04 <br />23921692 <br />SPOUSE SE Co :DECO 110• <br />_65:388471.513 <br />TAXABLE YEAR <br />?-rj I- I <br />LIEN NO' <br />041.56,0446 <br />CWNITY <br />HALL <br />DATE GF NOTICE <br />WE OF ASSESSMENT <br />66 <br />4/15/ 4 <br />THIS NOTICE at STATE TAX L'SEN 15 <br />REVENUE FOR INDIVIDUAL :AX <br />STATE OF NE3o.%Asr.A• W3110E IS HER1 <br />TAXES INCLUDING PENALTIES AND INTO <br />FROM THE TAXPAYER SPECIFIED ABOVE <br />THESE TAXES -CONSTITUTE A LIEN, IN <br />THE TAXPAYER OR HEREAFTER ACIVIRE] <br />AMOUNT Ur TAX • - <br />PEWALTY 0 a 0 * <br />INTEREST! (COMPUTED TO 0.6/04/, <br />VITAL ANPUNT DUE - - • • 0 4 <br />HEREBY CEqTiFY THAT THE NEBRASKJ <br />WITH THE REVENUE LAWS OF THE STAT; <br />THE AMOUNT SHOW4, TO BE DUEL AND TJ <br />AP16MET. DUE AFTER. DEMAND.. IF THIS <br />EXTENSION OF AN EFFECTIVE LTEWIT <br />THE STATEESS INITEREST IN THE AFFT.V <br />7 <br />PREPARERNS SIZI.. i TITLE <br />T i i 0 R I Z_ SIGNATURE TITLE <br />NEBRASKA DEPARTMENT OF REVENUE <br />Pfinted wM soy ink on recycied paper 1 <br />LARRY <br />10/19/2004 2004 11:04 AM <br />Notice of State Tax Lien <br />PLEASE DO NOT WRITE IN THIS SPACE <br />INCOME TAX <br />LARRY D K PAMELA N COWSLL <br />t2;? W STOLLEY , PARK RD <br />AMM'ISLAND ;INE 68801 <br />SSUED BY THE '-FIRASKA DEPARTMENT OF <br />�URSUANT 'TO TAE REVENUE LAWS OF THE <br />�Y GIVEN THAT "INDIVIDUAL 14COME <br />I i <br />REST . #HIGH ,14E OWN _H F <br />S BE LO it ARE DL <br />AND REMAIN UN AID AFTER DEMAND• <br />HE COUNTY FOR iPROPERTY BELONGING TO <br />• 667*0.4 <br />166*76 <br />bO4) -45 <br />879:3512 <br />DEPART141ENT OF, REVENUE HAS COMPLIED <br />'OF NEBRASKA ;N THE DETERMINATION OF <br />F_ T."WAYER HAS FAILED TO PAY THE <br />140TICE OF ISIA# TAX LIEN IS AN <br />.b_RVES TO CONTINUE THE PRIDDRITY OF <br />PROPERTY UP THE TAXPAYER- <br />*t. a w a 0 All 0 a L04�-10.4 all iw <br />DATE/TELEPHONEE <br />DATE <br />hate and Canary Copies TAXPAYER — Pink Copy <br />7. 145 -1979 Rev. 2-2000 Supersedes 7-146-109 Rev. 10-1995 <br />