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03%09/2003 15:57 FAX 14024714429 NEBRASKA LCC 1a002,/002 <br />NE Sec of Skete - UCC STC <br />9903274643 -5 Pss I <br />STN Please retumtu: Fi lepd: 05J09�12003 11:47 AM <br />STATE OF NEBRASKA <br />DEPARTMENT OF REVENUE <br />1811 WEST 2" STSTE460 �O030C 922 <br />GRAND ISLAND NE 68803 J e) <br />or <br />oaartata <br />40"Ismom <br />of rara�we <br />NOTICE OF STATE TAX LIEN <br />$e <br />This Notice of State Tax Lien is issued by the Nebraska Department of <br />Revenue for unpaid taxes pursuant to the revenue laws of the state of <br />Nebraska. Notice is hereby given that taxes including penalties and <br />Interest, which are shown below, are due from the taxpayer specified <br />below and remain unpaid after demand. These taxes constitute a lien <br />in the county for real and personal property belonging to the taxpayer <br />or hereafter acauirpd_ <br />IN THIS <br />Nebraska Identification Number <br />35596090 <br />Lien Filed With <br />Q Register of Deeds <br />Social Security Number <br />11 County Clerk 606 -46 -1281 <br />Spouse's Social Security Number <br />Llen Serial Number <br />030870140 <br />Lien Type <br />96ginal 0 Continuation Corrected <br />Date of Lien <br />04/18/2003 <br />County <br />Hall <br />Bus I NESS, NAME AND LOCATION <br />ADDRESS <br />TAXPAYER NAME AND MAILING ADDRESS <br />Business Name <br />Name <br />Sinakhone Siriphone <br />Street Address <br />Street or Other Melling Address <br />2023 W 3rd St <br />C'ty <br />State Zip Code <br />City <br />Grand Island <br />State Zip Code <br />NE 68803 <br />Tax <br />Category <br />Number <br />Tax Period <br />i <br />Date of i Amount of Tax <br />Assessment I ' <br />Penalty <br />Interest <br />Additions <br />Balance of <br />Assessment Due <br />22 <br />1999 <br />01/1412003 <br />395.00 <br />'19.75 <br />104.22 <br />518.97 <br />22 <br />2000 <br />01/0812003 <br />423.00 <br />21.15 <br />73.53 <br />517.68 <br />22 <br />2001 <br />01/08/2003 <br />408.00 <br />20.40 <br />34.20 <br />452.60 <br />TOTAL <br />$ _1,499.25 <br />��� r • �< , ; ...... a �eNa e —vdr lute nas uumpoeu wan me revenue laws oT the State of Nebraska In the <br />determinaton of the amount shown to be due; and the taxpayer has failed to pay the amount due after demand. If this Notice of State <br />Tax Lleq ip an enslon of an five lien, it serves to continue the priority of the state's interest in the affected property of the taxpayer. <br />14 '7 <br />t �^ TSS U 308 385 -6067 <br />Sign Preparer's Signature Title Date Telephone Number <br />here Revenue Supervisor p / <br />u ized i9 tur Title Dafa <br />4- 494 -1974 Rev. 2 -2002 Supersedes 4.494.1974 Rev. 1u-- 996 <br />V <br />