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03/06/2002 12:22 FAX 14024714429 NEBRASKA UCC 1a002/003 <br />I 0 <br />200202506 <br />Or Notice of State Tax Lien <br />nebnerr <br />apsdmed <br />or rwem e <br />PLEASE DO NOT WRITE IN TWS SPACE <br />This Notice of State Tax Leo 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 alien in <br />the county fur real and personal property belonging to the taxpayer or <br />L..— n•.p••— ••u.•..!Md <br />Y <br />Nebraska IdWMC Number Lisn Fled W1N <br />aaon <br />2325153D sterofDeeds❑Courtyclark <br />Social Serydt' or Fedoral i D. Number <br />512 -70 -4029 <br />Spouse's Social Security, Number <br />Uen Sorel Number Lien Type <br />000070256 Original ❑COnenuedon <br />❑Corrected <br />Date of Lien <br />02 -21 -02 <br />County <br />HALL <br />BUSINESS NAME AND LOCATION ADDRESS <br />TAXPAYER NAME AND MAILING ADDRESS <br />Business Name <br />Name <br />DANA J PETERSON <br />Sree1 Address <br />Sweet or Other Ma ing Address <br />522 E DIVISION ST <br />Glry Sate iq Code <br />city State <br />GRAND ISLAND NE <br />Zip Code <br />68801 <br />Tax <br />Category <br />Number <br />Tax Period <br />Date <br />ArseeeameM <br />Amount of Tex <br />Penalty <br />Interest <br />Adtlaiera <br />Balance of I <br />AsaeaementDue <br />22 <br />1997 <br />04 -27 -99 <br />0.00 <br />0.001 <br />236.96 <br />236.96 <br />22 <br />194-6 <br />09 -28 -99 <br />4589.00 <br />413.45 <br />1626.97 <br />6629.42 <br />Please rnum to: <br />STATE OF NEBRASKA <br />DEPARTPdENT OF REVENUE <br />1811 WEST 2ND ST STE 460 <br />GRAND ISLAND NE 68803 <br />TOTAL <br />$ 6866.38 <br />I hereby certify that the Nebraska Department of Revenue has complied with the reaenue laws of the Steve of Nebraska in hie detam inaeM <br />of the amount shown to he due, and hie taxpayer has failed to pay the amount due after demand. 9 this Notloe of State Tax Lien a an ettension of <br />an eoscwe Yen. RWjvm to continue the pnorly of the state's Mtaest In the Fected property of the ��taxpeyer. <br />Sign t� J H a L <br />here Prp afs Signature Title Date Telepnrn- <br />Q r s C, a <br />fi'✓ /w Ynlr/ <br />A dt nz a T41e <br />COUNTY OFFICE Gory Copy <br />NEBRASKA DEPARTMENT OF REVENUE -white and Goldenrod Copes r,XP., • E^ - • •••^ --rr aasx-rn Lam, teen supersede.4 4�t4 <br />6p me m mroru r <br />