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11/17/2004 17:29 FAX 14024714429 <br />i <br />f <br />NEBRASKA UCC <br />200411213 <br />lih 002/010 <br />NOTICE OF STATE TAX LIEN <br />t <br />PLEASE DO NOT WRITE IN THIS SPACE <br />This Notice of State Tax Lien is issued by the Nebraska Department of �^!( J. ^' <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 acouired. <br />Nebraska Identification Number Federal Identification Number <br />30612411 <br />Lien Serial Number Lien Filed With Social Security Number Spouse's Social Security Number <br />962080337 XQ Register of Deeds Q County Clerk 544-66 -6234 508 -86 -5944 <br />Date of Lien Lien Type County <br />08115/1996 Qorig' ! X Continuation 0Corrected HALL <br />BUSINESS NAME AND LOCATION ADDRESS TAXPAYER NAME AND MAILING ADDRESS <br />Business Name Name <br />LARRY W & KANDIE K COLSON <br />Street Address Street or Other (Nailing Address <br />1615 S LINCOLN #4 <br />City State Zip Code City State Zip Code <br />GRAND ISLAND NE 68801 <br />Tax <br />Category <br />Tax Period <br />I <br />Date of <br />Amount of Tax <br />Penalty <br />I <br />Interest <br />I <br />Additions <br />I <br />Balance of <br />I <br />Number <br />Assessment <br />Assessment Due <br />22 1990 06111/1996 465.00 116.25 244.75 826.00 <br />22 1991 06/11/1996 574.00 143.50 221.54 939.04 <br />I <br />22 1992 06/11/1996 i 476.38 119.10 126.75 722.23 <br />I I ; I - I TOTAL I$ 2,48727 <br />1 hereby certify that the Nebraska Departnjent 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 an extension of an eff ctive lien, it serves to continue the priority of the state's interest in the affected property of the taxpayer. <br />_ ([lL REVENUE AGENT l (% {jl� 402 471 -5835 <br />sign Pre er's i ature � Title Date �Telephope N um r� here v a� O i Au orized Signature Title • � ate <br />T <br />