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<br />10/25/2005 09:19 FAX 14024714429 <br /> <br />~~~~-- ~~_.............~,....-------------~~~~---" <br /> <br />. ------_................-~-.---~- <br /> <br />~ 0021006 <br /> <br />NEBRASKA Dee <br /> <br />200510564 <br /> <br />IIIII(r II" I~ 1'1 <br /> <br />9H5418975-& PQs: 1 <br />HAL.L.ER RLBERT J, <br />Flied: 10J24J20e6 02,48 PM <br /> <br />o~ <br /> <br />Please Return Original Copy to the <br />Nebraska Dept. of Revenue at 200 <br />South Silber, North Platte, NE <br />69101 <br /> <br />. <br />l\~1I6 <br />1IOf,fGi.....' ' <br />l!f~ <br /> <br /> <br />NOTICE OF STATE TAX LIEN <br /> <br />, , <br /> PLEASE DO NOT WRITE IN THIS SPACE <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 Identification Number Federal Identification Number <br /> 44096372 <br />Lien Serial Number Lien FiledWith SocIal Security Number Spouse's Social Se,curity Number <br /> 51~6()166 I,' :, IKI Register of D~eds o CountY C\9~ 508-48-8620 " <br /> , ' <br />Date of Lien Lien Type County .. " " " ... .' <br /> IKI Original 0 Continuation o Corrected " , <br /> 10/20/2005 ' HALL' . .. .,..' ~ <br />[ BUSINESS NAME AND LOCATION ADDRESS TAXPAYER NAME AND MAILING ADDRESS I <br />Business Name . Name <br /> ALBERT J HALLER <br />Street AddresS ' Street or Other Mailing Address <br /> PO BOX 1654 <br />City State Zip Code City State Zip Code <br /> , GRAND ISLAND NE 68802 <br />I Tax I <br />Category , ' Tax Period ' Date of Amount of Tax Penalty Interest Additions Balance of <br />Number Assessment Assessment Due <br />22 1998 05/31/2005 1,306.00 326.50 ' 635.69 2,268.19 <br /> - <br />22 1999 05/31/2005 134.00 33.50 53.13 220.63 <br />22 2000 05/31/2005 230.00 57.50 70.49 357.99 <br />22 2001 05131/2005 5,545.30 1,386.33 1,200.52 8,132.15 <br /> TOTAL $ 10,978.96 <br /> <br />sign ... <br />here ... <br /> <br /> <br />Revenue Agent <br />Tille <br />M-\ Revenue Senior Agent <br />Title <br /> <br />10 ..:J() -c-f)K <br />Date <br />