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02!03!2003 18:07 FAT 14024714429 NEBRASKA 6CC [a 002!003 <br />`LI <br />t' <br />V <br />phaeonii <br />STATE OF NEBRASKA <br />DEPARTMENT OF REVENGE <br />1811 WEST Zap ST STE 460 <br />GRAND ISLAND NE 68803 <br />tr NOTICE OF STATE TAX LIEN <br />�,mN1e <br />Qg4myA <br />imam <br />IN THIS SPACE <br />This Notice of State Tax Lien is Issued by the Nebraska Department of PLEASE DO NOT WRITE <br />Revenue for unpaid taxes pursuant to the revenue laws of the state of <br />Nebraska. Notice is hereby given that taxers Including penalties and <br />interest, which are shown below, are due from the taxpayer specified 200301409 <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 />Dr hereafter aeaulrnd- <br />Nasreaka Ider0cedon Number Lien °Iletl Wlih <br />sotlal Security 11 <br />Spouae'e Sri Security Nxi <br />7205546 <br />QReola*or of OOado <br />EjCourty Cerk <br />506 -64 -3732 <br />L'en Serial NumberLien <br />Type <br />Date o/ Llen <br />County <br />03 o <br />QOrglnal QContlnusher <br />�COrreetatl <br />OV29/2003 <br />Hall <br />B USINESS NAME AND LOCATION ADDRESS <br />TAXPAYER NAME AND MAILING ADDRESS <br />S-onneas Name <br />Name <br />Thomas P Mettenbrink <br />Street Add,.. <br />Street or Offer milling Addrai <br />1324 W North Ffunt Street <br />City <br />State zip de <br />City <br />Sure Zip Code <br />Grand Island <br />NE 68803 <br />rax <br />Caxriray Tax Pared <br />Number <br />Dab of Amount of Tax <br />Penalty Interest Addition, Balance of <br />001 <br />AYYeeYmant <br />ASSeYYnNnI DYa <br />01 <br />12r3112001 <br />12f3l/ <br />09/08/2002 899.18 <br />123.84 98.23 <br />1,121.25 <br />TOTAL <br />I Fereby cartlfy that the Nebraska Department of Rr ie bas laws o, the Slate of Nebmahe in the _ <br />determination of the amountahown ,p be di and the taxpayer has faller, b pay the amount due after dri If Into Nob. of Stale _ <br />Ti Lien i —s as teranion et afreutl a lien, a sane, to mntinue the priority of the state's intera@t in bre atfec:ee pmpery, of the bxpayer. <br />e Revenue Senior Auent 308 385 - 6073. <br />sign Prepare SIB - -- nature Re pate ccpc onTTTi— eAumbe� <br />here Revenue SUDervisor � arJ D <br />r' tle to <br />..'all a., 2�IDa! euncrsc ', 0.iBt'i Rb. 1 1.11i1 <br />