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01/07/2002 15:53 FAX 14024714429 <br />lJ <br />NEBRASKA UCC <br />1 <br />1a002/002 <br />TL <br />Z02 01:56 pm <br />I jk Notice of State Tax Lien <br />I <br />nebrai <br />depertnent <br />Wt revenue <br />Ibis Notice of State Tax Lien is issued by the Nebraska Department or <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 in <br />the county for real and personal property belonging to the taxpayer or <br />hereafter acuuired. <br />PLEASE DO NOT WRITE IN THIS SPACE <br />200200217 <br />Nebraska identification Number <br />10866848 <br />lien Fled With <br />Q Register of Deeds ❑ County Clark <br />Social Security or Federal I.D. Number <br />4.85 -52 -1460 <br />Spouse's Social Security Number <br />508$4 -3344 <br />Lien Serial Number <br />13130013 <br />Lion Type <br />[R Original Q continuation ❑ Corrected <br />Dote of Lien <br />01104/2002 <br />County <br />Half <br />13USINESS NAME AND LOCATION ADDRESS <br />TAXPAYER NAME AND MAILING ADDRESS <br />Business Name <br />Name <br />Denzel R & Cheryl Busick <br />Street Address <br />Street or Other Mailing Address <br />a -7 5rentv..,oi Place _ <br />Cry State Zip Code <br />City State Zip Code <br />Grand Island H X0$71 <br />Tax <br />Category <br />Number <br />Tax Period <br />Dale of <br />Assessment <br />Amount of Tax <br />Penalty <br />Interest <br />Additions <br />Balance of <br />Assessment Due <br />92 <br />1998 <br />06123/1999 <br />9,730.00 <br />496.50 <br />2,389.27 <br />12,615.77 <br />2 <br />05/16/2000 <br />9,853.00 <br />492.65 <br />1,528.16 <br />11,873.81 <br />29 <br />2000 <br />08/22/2001 <br />7,003.00 <br />726.15 <br />455.87 <br />8,185.02 <br />I <br />TOTAL <br />32,674.60 <br />I hereby certify that the Nebraska Department of Revenue has complied with the revenue laws of the State of Nebraska in the determination <br />of the amount shown to be due, and the taxpayer has failed to pay the arnoum due after demand. If this Notice of Stale Tax Lien is an extension of <br />an effecAve lien, it serves to continue the priority of the state'o interest in the affected property of the taxpayer. <br />A %,,,, <br />sign �� Revenue Agent cgoLL,S9S-2_C? <br />here i ' g Tie Date ZORLI <br />Revenue Supervisor AuRlorized Signature Title ; <br />NEBRASKA DEPARTMENT O EVENUE - White and Goldenrod Copies <br />�P-- -mww Nn. <br />TAXPAYER - Pink Copy COUNTY OFFICE . Canary Copy ' 11 <br />4 -49474 Rev. rP95 Supersedes 4.49+74 Rev S- <br />