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12'03!2002 16:06 FAX 14024714429 NEBRASKA LICC <br />la0o2'002 <br />III I I IIII ��I A�I VIII ��I �I YI� I I �I IIII <br />p9p919Yi9691 i -a PBS. t <br />FIIint 1221100012382 a2 38 pn <br />200213524 <br />or NOTICE OF STATE TAX LIEN <br />aem.e <br />etnxaee <br />e, <br />PLEASE DO NOT WRITE IN THIS SPACE <br />This Notice of State Tex Lien Is issued by the Nebraska Department of <br />Revenue for unpaid taxes pursuant to the revenue laws of the state of <br />T u Perlod <br />Nebraska. Notice is hereby given that taxes Including penalties and <br />Ai n i l of Tax <br />interest, which are shown below, are due from the taxpayer specified <br />InnoraH <br />below and remain unpaid after. demand. These taxes constitute a lien <br />aalar¢e at <br />in the county for real and personal property belonging to the taxpayer <br />or hereafter acquired. <br />Nebraska Id.rtflratien Number <br />uer Red W3h <br />Social Semrity Igumbar <br />Seouse's SorJel Secunb Number <br />8682526 <br />QRa9lsbrdoaada 7,j County CJerk <br />505 -06 -6493 <br />_Ten Banal Number <br />Len Type <br />Date of Lien <br />County <br />_ 0212239 <br />006911-1 E1Condnua9on Connected! <br />1 11/3012002 <br />HALL <br />ADAM DZINGLE <br />Sheet Address III or Other Melling Address <br />2512 CHANTICLEER If 7 <br />CeY Siete Zip Code Cib Suite Lid Cade <br />Tax <br />Category <br />Number <br />T u Perlod <br />Date N <br />Ai n i l of Tax <br />Penalty <br />InnoraH <br />Additions <br />aalar¢e at <br />- Aaeesamenl <br />Aasesemenl DUa <br />21 1213te2nntV� 11130/2CO2 200.00 1 50.00 1 14.99 <br />264.99 <br />I TOTAL I 49 <br />I „ereby candy that the Nebrasea Ceparemin of Revenue he. compiiod wit to reoenue laws d the Slate of Ned,o,2 in the <br />determinatbn d to amount shown to be due, and to uuq rer has Wiled b pay tle amount due aver demand. If this Notice of State <br />Tax Llen is n ladenaion of ar, effectiv li n, it serxs to continue to pnorlty of the sidte's Interest In�Ina affected pmpetly of tae bxpayar. ^ <br />sign raps ignau s RBe enue SeOr Ag2rtt /�/7 ✓At„�— 402471 -5727 <br />here 7 ..4CZ Revenue Senior Agent /„L -et-O� <br />A onzed Signature Title Date <br />