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W14/2003 09:25 FAX 14024714429 <br />NEBRASKA UCC fa003 /008 <br />99e3252447 -3 Paa f <br />CE hAMI b]00aC P <br />9 so Rn <br />200300542 <br />ea,aake <br />NOTICE OF STATE TAX LIEN <br />4t. <br />PLEASE 00 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 texas constitute a lien <br />in the county for real and personal property belonging to the taxpayer <br />of hereafter aeeuirna_ <br />Nebaala ldmhhadon NOmbar <br />34990880 <br />Lim Filed With <br />XZRgishal Dead. ElCounry Clerk <br />social security Number <br />505 -72 -4361 <br />Sppuae'a 5mcal 5ecudly Number <br />506-76 -9581 <br />Lien Serial NV her <br />012290080 <br />Jan Type <br />Qoryx,al �C.nmus,.r Elan —tea <br />Date o'LIM <br />01/10/2003 - <br />povdy <br />HALL <br />BUSINESS NAME AND LOCATION ADDRESS <br />TAXPAYER NAME AND MAILING ADDRESS <br />9u.m..a Nam. <br />Nam. <br />DONALD P 8 CATHLEEN HAl1SSERMANN <br />sheet Addreea <br />Sheet er OM.r Maims Adel <br />4954 W HWY 307 EOX 25P <br />City Shia Do Code <br />Chy stab, 2.p Coda <br />ALDA, NE 68810 <br />Tax <br />Category <br />Number <br />Tax P.riod <br />Dateof <br />Aeaassma.t <br />Amwlol Tax <br />Penalty <br />Interest <br />Additions <br />Balce o/ <br />Balm ...f <br />Due <br />22 <br />2000 <br />05/2512001 <br />622.92 <br />31.96 <br />97.33 <br />752.21 <br />I hemby <br />certfiithat Ma <br />Nebraska Demrtmml <br />nr ae,a.��n e�.....,..par <br />TOTAL <br />$ 752.21 - <br />deMr- nineton aline emovll shmm to be due, eM tl]e hkpayer tae h11atl ro pay the mount due ahr demand. If this Nolke or 5tate <br />ew ien iaa lb,nalcn drEll,a KM. if ,[sarvmW -Mm- primly dthe ataze' e inuvan,n the affected pmoedy W Me Wpeye, . <br />lf.�l� n.o Revenue "nit 1 ((} Q 402 471 -5835 <br />sign pr, ramyfure Ttlle a;e Telephone NU ber <br />here VSI Revenue Scpervlsor <br />Adhw,m Signature Ialle �� <br />Ooh <br />9 -0.H374 Rev. b30a35uper�tlu 6 @4.(C/[ Rw. vL1p.: <br />