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01/11/2002 16:41 FAX 14024714429 NEBRASKA UCC Q004/004 <br />J� <br />0 <br />Or <br />depedroont <br />of rwenw <br />NL see of 94.46 - ucc 37L <br />1 <br />I 2188 I I <br />10 Poi: 1 <br />JOBS DARWIN i <br />Filed: OIJI112002 02:26 PM <br />Notice of State Tax Lien <br />This Notice of State Tax Dien 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 defraud. These taxes constitute a lien in <br />the county for reel and personal property belonging to the taxpayer or <br />PLEASE DO NOT WRITE IN THIS SPACE <br />200200482 <br />Nebraska Identification Number lien Filed Wth <br />Social Security or Federal I.D. %umber <br />Spouse's Sodal Security Number <br />40195686 [j Register of Deeds ❑ cc" Clerk <br />507-36-3174 <br />lion serial Number UenType <br />002520144 ® Original ❑ Continuation <br />❑ Corrected <br />Date of Lien <br />12/30/01 <br />County <br />HALL <br />Busmess NAME AND LOCATION ADDRESS <br />TAXPAYER NAME AND MAILING ADDRESS <br />Business Name <br />Name <br />DARWIN J JACOBS <br />Street Address <br />Street or Other Malkq Address <br />6101 SEQUOIA H 10 <br />Cty State Zp Co" <br />City Slate <br />Zip Code <br />ALBUQUERQUE NM <br />87120 <br />ax <br />Cat�gory <br />Tax Period <br />AwnsemarR <br />Amount of Tax <br />Penalty <br />Irrteraat <br />Additions <br />Balanee of <br />AsaesarnentDua <br />Number <br />22 <br />1999 <br />6/21/00 <br />201.00 <br />10.05 <br />30.93 <br />241.98 <br />Memo retum to: <br />STATE OF NEBRASKA <br />DEPARTMENT OF REVENUE <br />1811 WEST VD ST STE 460 <br />GRAND ISLAND NE 68803 <br />TOTAL <br />$ 241,98 <br />I hereby certify <br />of the amount shown <br />an effootive fig, It pi <br />sign <br />here <br />NEBRASKA DEPARTMENT <br />wi'w - MW-W AW <br />the Nebraska Department of Revenue nas compuse wnn ure revenue iewa ur u its —tv v. —I no,.o .I a —. -- „ -11 <br />e due, end the taxpayer has tailed to pay the amount due after demand. it this Notice of State Tax Lien is an extension of <br />,to ppndnw the priority at the state's Interest In the affected Property 01 Uw taxpayer. <br />Two DO" Telephone No. <br />TIUe t . <br />F REVENU - hite and Goldenrod Copies TAXPAYER - Pink Copy COUNTY OFFICE - Canary COPY <br />4-494-74 R9V. 1015 SUPOM90oe 4499"74 Rev. 6 -96 <br />