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11/30/2004 18:11 FAX 14024714429 <br />NEBRASKA UCC <br />IA 003/006 <br />1! SM-c of 11CC STL <br />20041157 <br />9904361876 -5 P °z: 1 <br />BARKER CHARLES 5 <br />Filed: 11/23/2004 04:16 PM <br />Or NOTICE OF STATE TAX LIEN <br />*Wft"t <br />PLEASE DO NOT WRITE IN THIS SPACE <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 />Nebraska Identifcation Number Federal Identification Number <br />30334349 <br />Lien Serial Number Lien Filed With Social Security Number Spouse's Social Security Number <br />40440358 X❑ Register of Deeds [] County C]erk 508 -92 -2034 <br />Date of Lien Lien Type County <br />11/18/2004 0 original 0 Continuation Corrected HALL <br />BUSINESS NAME AND LOCATION ADDRESS TAXPAYER NAME AND MAILING ADDRESS <br />Business Name Name <br />CHARLES S BARKER <br />Street Address Street or Other Mailing Address <br />423 W 6TH <br />City State Zip Code City - State Zip Code <br />(;RAND iG1 Amn nic aaani <br />Tax <br />-- - • -- <br />-- ••-- <br />Category <br />Tax Period <br />Date of <br />Amount of Tax <br />Penalty <br />Interest <br />Additions <br />Balance of <br />Number. <br />Assessment <br />Assessment Due <br />22 2000 12/23/2003 285.00 14.25 76.16 375.41 <br />' 1 ' 1 TOTAL 1$ 375.41 <br />I hereby certify that the Nebraska Department of Revenue has complied with the revenue laws of the State of Nebraska in the f� <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 y1! <br />. Tax Lien i 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 11/18/2004 402 471 -5835 <br />sign Prepay 's Signature Title Date Telephone Number <br />here ! / //�R 7— l� -LZ -di <br />G <br />uthorized Sig ature Title r� Date <br />.4- 494 -1974 Rea. 2 -2002 SUpersetles 4-494 -1974 Rev. 10-1995 <br />