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03- 04/2002 17:59 FAA 14024714429 NEBRASKA DCC 005/007. <br />�1 <br />Please retumto: <br />STATE OF NEBRASKA <br />DEPARTMENT OF REVENUE <br />1811 WEST 2" ST STE 460 <br />GRAND ISLAND ATE 68803 <br />Or <br />mania" <br />aekartmmt <br />et revenue <br />20020214431 <br />Notice of State Tax Lien <br />PLEASE DO NOT WRITE IN THIS SPACE <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 or <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 acoulred. <br />Nebreeaa Identification Number <br />11386932 <br />lion glad WIN <br />L$RegisterotDseds11Cram V— <br />Social Seeeayw Fedora! I. D. Number <br />505 -42 -1018 <br />Spouee'a SoCml wady Number <br />Uen Serial Number <br />020110109 <br />Uen Type <br />k7 Orglnel [CCrrtinuatWn ❑c«rxtz02 <br />Dale el lien <br />-14 -02 <br />County <br />HALL <br />BUSINESS NAME AND LOCATION ADDRESS <br />TAXPAYER NAME AND MAILING ADDRESS <br />Business Name <br />Narrc <br />JAMES H OLIVER <br />Street Address <br />City sues - - Zip Code- -- <br />Bbeet or Other Mating Address <br />PO BOX 2222 <br />City State Zlp Code - <br />GRAND ISLAND NE 68802 <br />ax <br />Cat ry <br />Tax Perlad <br />As Oaks of <br />Amount of Tax <br />Penalty <br />Interest <br />Additions <br />Bslanent <br />AaeessmentDw <br />22 <br />1999 <br />11 -15 -00 <br />21174.00 <br />1683.70 <br />3498.06 <br />26,355.76 <br />22 <br />2000 <br />10 -16 -01 <br />4016.00 <br />617.60 <br />302.03 <br />4935.63 <br />TOTAL <br />$ 31,291.39 <br />neraby certfiy Nat the Nebraska Deparanelr of Revenue has conpliad WIM Vte revenue fa s of Ina State of NeMaelm In Na oetermNaton <br />of the emourx ahown lobe due, and the taxpayer has }ailed to paylhe anaum due after dome %, If this N011re of Sims Tax Lien Is an extension d <br />an aRogiltli liar, it aervea tocondnue Pe pdorny of the gates intamat in the eifecw Property of the le.peyer. <br />s i g n A'(Iraek <br />here re s Signature rate Otis TdW In 7o. <br />AJboriz al a a «att "j: �'-� ✓,s •� 4.7 1 <br />�-- Uses I <br />NEBRASKA DEPARTMENT OF REV E E- Nine and Goldenrod Copies TAXPAYER - Pink Copy COUNTY OFFICE - Canary Crary <br />c W— .,6 r 4-4,4-14 n tact SLpenedee a-a4414 Fev. 545 <br />