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12/17/2004 17:49 FAX 14024714429 <br />I <br />Or <br />nebraska' <br />department <br />o1 revenue <br />NEBRASKA UCC <br />20041216/8 <br />Q007 <br />Notice of State Tax Lien <br />PLEASE DO NOT WRITE IN THIS SPACE <br />INDIVIDUAL INCOME 7AX. <br />S0C. SEC• NVs <br />I <br />505709068 <br />NERR• IDENT- N11- <br />IgDD7439 <br />SPOUSE SOC. .SEC- NO- <br />TAXABLE YEAR <br />l 2003 <br />LIEN NO- <br />0,4 5540070 <br />COUNTY <br />l HALL <br />DATE OF NOTICE <br />09/10/1004 <br />004 <br />DATE OF ASSESSMENT <br />ro6jZZ/200 r <br />DENNIS KELSON <br />3575 N HWY281 <br />r,, AND ISLAND 'RE 6S i <br />THIS th7TICE OF STATE TAX LIEN IS IS <br />REVENUE FUR INDIVIDUAL INCU TeX P <br />STATE Of NEBRASKA- NOTICE IS HEREB <br />TAXES lKLUDING PENALTIES AND INTER <br />FRDM THE TAXPAYER SPECIFIED AB ,. E A <br />THESE TAXES CONSTITUTE: 'I A LIEN IN T t <br />THE TAXPAYER OR HEREAFTER ACQUIREDO <br />AMOUNT Of TAX - • I • a • ! ! • <br />PENALTY Y ! s • 0 s. 0 • • a a s <br />INTER ST (COMPUTED TO ��J3�1� <br />TOTAL - AMOUINT DUE 1 • . • • . a a <br />I HEREBY CERTIFY THAT THE NEBIRASKA <br />WITH THE REVENUE LAWS PF THE STATE <br />THE AMDUN'T SHOWN TO B5 DUE j AND T <br />AMOUNT DUE AVER DEMANP• If THIS <br />EXTESI Ur <br />AN LECTIVE LIEN iT <br />THE STA4TE*S INTLR.EST Ik THE AF ECT-E <br />ED BY 'THE NEBRASKA DEPARTMENT OF <br />SUANT TO TIE REVENUE LAWS OF Tilt <br />GIVEN THAT INDIVIDUAL INCOME <br />T9 WI ICH ARE SHOWN BELOW, ARE DUE <br />REMAIN UNPAID AFTER DE.MAND.- <br />COUN TY FOR . PROPERTY .BELONGING <br />IZO 45 <br />4) 6s06 <br />a • • • • 267 -53 <br />EaARTMEHT OF REVENUE HAS . CD1T<LI.ED <br />iF 3L MINA7IUT OF <br />TAXPAYER HAS FAILED TD PAY THE <br />;ZICE OF STATE TAX LIEN IS AN <br />SRVEES TO CONTINUE THE PRIORITY Of <br />PROPERTY OF THE <br />ERGS "a sE <br />••a • II a�i'tisisi��ss -� -•s <br />"THDRI i .SIGNATURE. TITLE <br />NEBRASKA DEPARTMENT OF REVENUE — V1 hits and Canary Copies <br />DATElTELEP.40h12 +r/ <br />DATE <br />TAXPAYER — Pink Copy <br />7 -145 -1979 Rev. 2 -2000 Supersedes 7-145 -1979 Rev. 10.1995 <br />