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07/15/2003 15:54 FAX 14024714429 NEBRASKA DCC <br />200309056 <br />Please forward to: <br />Nebraska Department of Revenue <br />4500 Ave 1 PO Box 1500 <br />Scottsbluff NE 69363 -1500 <br />Or <br />nebraska <br />aepartment <br />ofrevenue <br />Z002/003 <br />Notice of State Tax Lien <br />PLEASE DO NOT WRITE IN THIS SPACE <br />TERMIRAMON, OF ' STATE TAX L.IEK <br />: b6ivIDUAL INC114E TAX <br />If YOU INWIRE +SMUT .YWR <br />ACC 'Tp REFER TO THESE WMERS. <br />Soc- SEC:. NEI* 280641776 <br />ME81tr{ . - ;DENTS- mo. 3' 293246 <br />SPOiJ.7lr `t OC. � SEC#- <br />TAxASLE YEAR 19% HIEEK01 PAftLA- 1P1A*O <br />LIgiT Has 972340014 3510:0 9TH-ST LOT-.147 <br />L.YEN RELEASE -,, N @r 031680703 CARTER LAKE IA 51910 <br />T�r <br />COUR N4 t� <br />KITE.: OF . HISTICE +6f` 3 <br />INS TRU14E . liiD. VC-C <br />iNsTRUMENT No. CTY <br />PURSUANT T6 THE REVENUE LAWS , OF THE STATE OF NEBRASKA# NOT —ICE IS <br />HEREBY. SIVEN- 1BY''THE NEBRASKA DEPART14ENT OF REVENUE -TuAT THE <br />STATE TA )(' L.IEW; WHICH ' HAS GEEN DULY FILED AGApsT THE Asim NAMED <br />TAXPAYER FUR INDIVIDUAL "1HCOME TAMES I5 TERMINATED. <br />I fiEREBY CERTIFY . T"AT THE REBRASKA DEPARTMENT Of REYENUIE HIS COMUED <br />WITH THE - iZEYENVc LAWS VF TIME STATE OF NEBRASKA ` IN 'THE ,DETERMINATION " OF <br />THIS TERMINATION* <br />• � � .4/' i s � a . ♦ _ s � �';Q'i�*'i 1i'�1r'�.(d a . � . � i s s � �a41i �ii5✓ . <br />PREP `S S TI DATE <br />UTHOR D "SISSNATURE TLE <br />PLEASE RETAIN . THIS NOTICE WITH YOUR PER14AW-NT RECORDS. <br />L <br />NEBRASKA DEPARTMENT OF REVENUE — White and Canary Copies TAXPAYER. — Pink Copy <br />Printed wiffl soy ink cr recycled paper 7 -145 -1979 Rev. 2 -2000 Superseles 7- 149 -1979 Rev. 1 C -1995 <br />a <br />