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04/25/2002 15:12 FAX 14024714429 NEBRASKA UCC 2003/003 <br />us see of state - utc vi. <br />so <br />fill <br />d1 T 1002 Z11 036 -1 Fps: <br />Filed:D0�4A�T2002 10.17 AM <br />O Led t1 J �c <br />cu to "s = V <br />4� V) W <br />.s--� O ti <br />V � <br />» t <br />Notice of State Tax Lien <br />v� d"r"*M <br />i of r«snw <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 of <br />Nebraska. Notice is hereby given that taxes including penalties and <br />Interest, whkh are shown below, are due from the taxpayer Specified <br />below and remain unpaid after demand. These taxes constitute alien in <br />the county for real and personal property belonging to the taxpayer or <br />hereafter acquired. <br />PLEASE DO NOT WRITE IN THIS SPACE <br />200204546 <br />Nebraska IderltlAcadon Nunoer <br />$290199 <br />Uen Fled With <br />AagleterofDaads [I courtlyaerk <br />Social S,ecurty or Federal I.D. Number Spouse's Social Security Number <br />505 -20 -4464 <br />Lien gal`/ 7 r . <br />�. <br />r <br />Lien Type <br />Roriginel ❑ Continuation ❑ Corrected <br />Date of Uen <br />03/18/2002 <br />County <br />1 Hall <br />BUSINESS NAME AND LOCATION ADDRESS <br />TAXPAYER NAME AND MAILING ADDRESS <br />Business Name <br />Name <br />Dorothy K Dahms <br />Street Address <br />Strast or Other Mailing Address <br />20 St James Piste <br />City State Zp Code <br />City State Zip Code <br />rand Island NE 65803 <br />TIK <br />F ategory <br />Number <br />Tax Period I Date of <br />Asseaament <br />Amount of Taos <br />Penalty <br />Interred <br />Additions <br />Balance of <br />Atsseaement Due <br />n <br />02101/2000 <br />(1313112000 <br />03// 812002 <br />1,865.18 <br />186.51 <br />325.97 <br />2,377-66 <br />I <br />I <br />I <br />TOTAL <br />$ <br />I hereby certify that the Nebraska Department of Revenue has Complied with the revenue laws of tlm State of Nebraska in tree determination <br />of the am I sWvn to be due, and the taxpayer has failed to pay the amount due after demand. It this Natica of State Tax Lien Is an extension of <br />an tive Ii n it serves to continue the priority of the at in the affected property ofZe taxpayer. <br />Sig G'r Revenue Agent <br />here pre &/s Signature Title Date Telephone No. <br />Revenue Supervisor 10PI G i- <br />�— Tale Date <br />Authorued rgretture <br />y� <br />NEBRASKA DEPARTMENT OF REVENUE - White and Goldenrod Copies TAXPAYER - Pink Copy COUNTY OFFICE - Canary Copy i <br />42d p1,ro0 on =yew MW 4 -49474 Rev. 10.95 SLipersWe3 4-494 -74 Rev. 5-35 <br />