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08/12/2002 15:46 FAX 14024714429 <br />b� <br />Pleess ratum to: <br />STATE OF NEBRASKA <br />DEPARTIvfENT OF REVENUE <br />1911 WEST 2 "D S E 68803 <br />GRAND ISLAND N <br />I r <br />.ae,.rU <br />•prYnr„1 <br />a reraaee <br />NEBRASKA DCC <br />200208527 <br />f&03/003 <br />NE fm N e4�M - YCC eTL <br />eea2 Pea:�t <br />Filed�0YN12 /2002 11:26 9M <br />NOTICE OF STATE TAX LIEN <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, which are shown below, are due from the taxpayer specified <br />below and remain unpaid after demand. These taxes constitute a lien <br />in the county for real and personal property belonging to the taxpayer <br />or hereafter acquired. <br />Nebraska Ideate cation Number <br />99621185 <br />Lien Filed With <br />QReglsterofDeeds <br />❑County Clerk <br />Social Security Number <br />505.90 -9808 <br />Spouse'o Social Security Number <br />Lien Serial Number <br />002590094 <br />Lien Type Date of Lien <br />[K Origlnal E]Continuation E] Corrected 1 08108/2002 <br />County <br />HALL <br />BUSINESS NAME AND LOCATION ADDRESS <br />TAXPAYER NAME AND MAILING ADDRESS <br />Business Name <br />Name <br />SUSAN R BECK <br />Street Address <br />Street or Other Mailing Address <br />2122 W. WAUGH ST <br />City <br />State Zip Code <br />City <br />GRAND ISLAND <br />State Zip Code <br />NE 68803 <br />Tax <br />Category <br />Number <br />Tax Period <br />Date of <br />Assessment <br />Amount of Tax <br />Penalty <br />Interest <br />I <br />Additions <br />Balance of <br />Assessment Due <br />22 <br />1999 <br />05/24/2000 <br />400.00 <br />1 21.10 <br />83.98 <br />505.08 <br />0.00 <br />0.00 <br />0.00 <br />0.00 <br />0.00 <br />TOTAL <br />$ 505.08 <br />I hereby certify that the Nebraska Department of Revenue has compiled with tie revenue laws of the State of Nebraska In the <br />determination of the mount shown m be due, and the taxpayer has failed to pay the amount due after demand. If this Notice of State <br />Tax Lien is an to Ion of l" Clive lien, it serves to continue the priority df the state's Inter In t // q18 affected property of the taxpayer. p� <br />Revenue Agent O/O4L-- 308 385 -8072 <br />sign Pr rats Signalre Title Dais <br />Te ph a umber --+' <br />here Revenue Supervisor pZ� <br />tharized Title Date <br />44841974 Rev 2.2002 euyenedes"94.1974 erv. 10 -1995 <br />