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, CDW— <br />ME T <br />O <br />N <br />C/J O <br />Q. O <br />'a lV <br />M <br />J <br />04/25/2002 15:11 FAX 14024714429 NEBRASKA UCC <br />t� <br />�1 p <br />T � b <br />E` <br />-, F `,J <br />LSD <br />bb <br />CV Y <br />tf = V <br />Cc v u <br />0 CV <br />�Ir <br />a.brasks <br />dsprhtsnt <br />I revenue <br />l' <br />o a r <br />V V <br />W <br />im <br />IM 002 /003 <br />KATHY <br />94J2512002 10:17 AM <br />Notice of State Tax Lien <br />PLEASE DO NOT WRITE IN THIS SPACE <br />This Notice of State Tax Tien 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 for heal and personal property belonging to the taxpayer or 200204547 <br />haroaRar ornuir#A_ <br />Nebraska Ide illftation Number <br />8290199 <br />Lien Fled With <br />Register of Deeds ❑ County Cterx <br />Social Security or Federal I. D. Number <br />Spouse's Social Security Number <br />U ial NY m�b� <br />.� Y • ��� <br />Lien Type <br />Orioinal ❑ Continuason ❑ Corrected <br />Date of Un <br />03(1$12002 <br />CO^ <br />Hall <br />BUSINESS NAME AND LOCATION ADDRESS <br />TAXPAYER NAME AND MAILING ADDRESS <br />Business Name <br />Name <br />Kathy Da;ims <br />StreetAdcress <br />Street or Other Mailing Address <br />20 St James Place _ <br />City State 23p Code <br />City State Lp Code <br />Grand Island NE 68803 <br />T <br />Catesgqory <br />Numk »r <br />Tax Period <br />Data of <br />�4saeosntant <br />Arttobutt of Tax <br />Penalty <br />Interest: <br />Additions <br />Duo <br />=AwoW f <br />01 <br />02/01/2000 <br />08/31/2000 <br />03/18/2002 <br />4,191.82 <br />616.20 <br />737.62 <br />5,545.64 <br />21 <br />0410112000 <br />061 012000 <br />03118/2UU2 <br />385.05 <br />77.01 <br />56.49 <br />51$.55 <br />TOTAL <br />$ <br />i <br />i <br />`v <br />1 her that the Nebraska Departnent of Revalue has complied with the revenue laws of ft State of Nebraska in dw datemtination <br />cf tt ee Jnt 9 n to be due, and the taxpayer has fail y amount due alter demand. If this Notice of Slate Tax Lien is an extension of <br />an try Yen, serves t nue me priority of tfles s ' In the affected property at the taxpayer, <br />sign Revenue Agent I �4 <br />here sp r signs re r^ Title t Telephone No. <br />Revenue Supervisor �--- <br />Authorized SI lure Thle Date <br />NEBRASKA DEPARTMENT OF REVENUE - White and Goldenrod Copies TAXPAYER - Pink Copy COUNTY OFFICE - Canary Copy 1 t <br />O...d . —ydM 14 4499474 Rev. 1 a95 Supersedes 44494.74 FWv. S -95 <br />