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08/10/2005 16:43 FAX 14024714429 NEBRASKA UCC 0002/002 <br />wip <br />Ir <br />Nis Sac s# 94440 � UCC STL <br />99t►n407198 <br />�ilied 5081110 N 0 0r 09:19 A <br />�easeReturrn Original Copy to the <br />pt. of Revenue at 200 <br />North Platte, NE <br />20050779.1 <br />NOTICE OF STATE TAX LIEN <br />This Notice of State Tax Lien is issued by the Nebraska Department of PLEASE DO NOT WRITE IN THIS SPACE <br />Revenue for unpaid taxes'pursu.ant to -the revenue.laws of the state of <br />Nebraska. Notice is hereby given that taxes including penalties and <br />iriterest,•which are shown below, are due-from- the - taxpayer - spe=cified <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 />36362328 <br />Lien Serial Number Lien Filed With Social Security Number Spouse's Social Security Number <br />40440344 _ XC7 Register of Deeds • County Clerk 50t3 -86 -4956 506 -96 -0930 <br />Date of Lien . , , , - . • , Lien Type: County <br />08/08/2005 . Q Original O Continuatioh 0 Corrected HALL , <br />BUSINESS NAME AND LOCATION ADDRESS TAXPAYER NAME-AND MAILING ADDRESS, <br />Business Name Name <br />RUSTIN D. &CARRIED. BEAVERS <br />Street Address Street or Other Mailing Address <br />16008 COSNER RD <br />City State Zip Code City State <br />Tax AUBREY TX <br />Category Tax Period Date of Amount of Tax Penalty Interest Additions <br />Number Assessment <br />22 2000 12/23/2003 429.63 43.18 232.86 <br />Zip Code <br />73223 <br />Balance of <br />705.67 <br />TOTAL 705.67 <br />I hereby certify that the Nebraska Department of Revenue has complied with the revenue laws of the State of Nebraska in the <br />determination of the amount shown to be due, and the taxpayer has failed to pay the amount due after demand. If this Notice of State <br />Tax Lien is an extension of an effective lien, It serves to continue the priority of the state's interest in the affected property of the taxpayer. <br />Revenue Agent Q 308 535 -8294 <br />sign Pr rer's Si now <br />9 Title Date Telephone Number <br />here Revenue Senior Agent go-g-0-5— <br />I. Author' Signature Title Date f <br />4 -494 -1974 Rev. 2 -2002 Supersedes 4 -494 -1974 Rev. 10 -1995 /) <br />