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12/17/2004 17:48 FAX 14024714429 NEBRASKA UCC <br />Cg <br />Or <br />n9braska <br />department <br />of revenue <br />Socs, SEC * "Do <br />NE$Re MNTa NU. <br />SPOUSE SGC• ,SEC- NO- <br />TAXABLE YEAR <br />LIEN NG• <br />CtriY <br />DATE OF WJTICE <br />DATE OF ASSESSMENT <br />200412167 <br />Q006 <br />ws S" of ste4k. - ucc srt <br />11 <br />i <br />9I3043b83191 Pas: 1 <br />NELSON DENNIS <br />Filed: 12/16/2004 03:56 PM <br />Notice of State Tax Lien <br />INDIVIDUAL INCUMFE T <br />505709068 <br />12007434 <br />2002 <br />04263.6671 <br />HALL <br />PLEASE DO NOT WRITE IN THIS SPACE <br />DENNIS NELSON . <br />3*579 N N! 281 <br />DRAW 5-LA ' �'E 68801 <br />THIS NC TICE STATE ..TAX IEN , IS ISSUED BY THE NSMASXA D:EPUT:�NT OF <br />REVENUE FOR I.NDIVIDUAL, IN�00 TAX PURSUANT TO THE REVENUE LAWS . TNi <br />STATE OF NEBRASKA- TIC IS HEREBY, sIY*.,.N T14AT j -1f4D1 rTr)U,AL INCEME <br />TAXES INICLU:) r 9 PENALTIES A ` INTERESTr : WHICH ARE SHOWN BELOV. ARE DUE <br />FRUM TPE TAXPAYER SPECIFI:D ASO .. AND REMAIN UNPAID ASR DEMAND,* <br />THESE TAXES CONS TITUTE ; A .LIEI�t`- IN. Tof COUNTY FOR .PROPERTY BELONGIN£ TO <br />THE TAXPAYER OR PIEREAfTER _ 1�� C <br />1AH_"T s. s; OF TAB . . 24500 <br />PENALTY i • . s s • a . • •,.._�s, +1 s # s s • s • <br />INTEREST (CGMPUTED.',, .. r.#° 9 /IT /ZID0 4) s s . y . ! <br />TOT AL AMi3 UT DW, . • • • ! ..,• s • s • • . a Z • $ <br />I firREBY CERTIFY THAT THE NEBRASKA DEPARIME �T Gr REVENUE NAS COMPLIED <br />WITH TW- . RE'�ENUE LAWS.. OF THE ' STATE DF NiE- AS��#.. � THE �TT�tN�+iAT�[UN <br />TH E A MOUNT SH13WH Tfl B c .. j AND THE TAXPAYER HAS FAILED TO PAY THE <br />AMOUNT DUE AFTER DEMAND IF Yl�IS NOTICE 3F STATE TAX LTFfN " IS AN <br />EXTENSION F %N EFFECTIY LIyN IT SERVES TO CONI TNUE THE PRIORITY OF <br />THE STATES INTEREST IN tIME AFFECTED PROPERTY OF THE TAXPAYER- <br />THE <br />.ef t Sala •iYi�i.•. •sV.soa �afs <br />.. . .. -.. a DATE!'1 LED't i+lE VAD92*S SIGN OR <br />TLT <br />• <br />SI4,57NATURE TITI -2- <br />NEBRASKA DEPARTMENT OF REVENUE — White and Canary Copies <br />owes <br />TAXPAYER— Pink Copy <br />7- 145-1979 Rev. 2 -2000 Supersede3 7-1 A5 -1979 Rev. 10.1995 <br />