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11/21!2002 17:03 FAX 1.4024714429 NEERASRA LCC ®002/003 b�1 Or 200212992 �I Filed: 1112112002 02:50 PM Notice of State Tax Lien PLEASE 00 NOT WARE IN TNI6 SPACE INDIVIDUAL INCOME TAX SOC. SEC. NO. =09948368 NEBR. IDENT. NO. 31108296 SPOUSE SOC. SEC. ND. TAXABLE YEAR 2001 LIEN NO. - 023120056 COUNTY HALL JON JOMES DATE OF NOTICE 11/08/2002 723'W IDTH AT DATE OF ASSESSMENT 06/25/2002 GRAND ISLAND HE 68801 THIS NOTICE OF STATE TAX LIEN IS ISSUED. BY THE NEBRASKA DEPARTMENT OF REVENUE FOR INDIVIDUAL INCOME TAX PURSUANT TO THE REVENUE LAWS OF THE STATE OF NEBRASKA. NOTICE IS HEREBY GIVEN THAT INDIVIDUAL INCOME TAXES INCLUDING PENALTIES AND INTEREST, WHICH ARE SHOWN. BELOW ARE DUE FROM THE TAXPAYER SPECIFIED ABOVE. AND REMAIN UNPAID AFTER DEMAND. - THESE TAXES. CONSTITUTE A LIEN IN THE COUNTY FOR PROPERTY BELONGING TO THE TAXPAYER OR HEREAFTER ACQUIRED. AMOUNT OF TAX . . . . . . . . . . . . is 981.00 PENALTY . . . . . . . . . 53.03 INTEREST (COMPUTED . TO 11/08/2002) . ... . . . . . :52.34 TOTAL AMOUNT DUE . . . . . . . . . . . . . 19086.39 I HEREBY CERTIFY THAT THE NEBRASKA DEPARTMENT OF REVENUE HAS COMPLIED -WITH THE REVENUE LAWS Of THE STATE Of NEBRASKA IN THE DETERMIMATION OF THE AMOUNT SHOWN TO BE DUE, AND THE TAXPAYER HAS FAILED TO PAY THE AMOUNT DUE AFTER DEMAND. If THIS NOTICE Of STATE TAX LIEN IS AN EXTENSION OF AN EFFECTIVE LIEN'IT SERVES TO CONTINUE THE PRIORITY OF THE STATE'S INTEREST IN THE AFFECTED - PROPERTYOF THE TAXPAYER. (965) P•• AR 1 SJf ATURE TITLE DATEITELEPNON'c .u.... u•. as. u..uu a • . «1.. .•.•" •••a. •u1•. u• p� AUTHORIZED SIGNATURE TITLE DATE '1l` NEBRASKA DEPARTMENT OF REVENUE –White and Canary Copies TAXPAYER – Pink Copy e�roe.nn mr �1n >- 'as -sn Oa. eesso a.— s<. is -lase