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09/02/2005 16:12 FAX 14024714429 NEBRASKA UCC
<br />- -•
<br />200508717
<br />NOTICE OF S
<br />Ir
<br />TATE TAX LIEN,"..,. .
<br />nobr�k�
<br />dpdonrnaN .
<br />of f4venu+
<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 pyrsuant -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 />remain unpaid after demand. These taxes, constitute a� Tien
<br />below and p
<br />be{on in to the taxpayer
<br />r real and ersonal property belonging .
<br />in the county for personal
<br />r hereafter ac ulred.
<br />'
<br />Federal I- denti - Number
<br />on
<br />Ne bra ska Identification. N umloe
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<br />- -
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<br />7939248 -
<br />base's °Social Ity' N , -
<br />Lien Filed With
<br />I amber, �._ „: ,,.;.,;, �',,: �' ,:��, :'r;ir� �:,;:• - ":� +�'. .
<br />Lien Serial N m
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<br />Lien.T' e' Y.; :,,li' ,:.t" �- :•::,.i" +:,�;:,;`:,. Itij';;'
<br />ien � �'� `':lea: f t. ..r'4'.:. • '"�:,;.,;�` , ,�• „•,, ;,.. ,
<br />Date a .�, .':_• ;;:':•,.•.;;,:,, rf, ;;.tu,,Y •,7 ,.w:•:.:;
<br />rect
<br />Cored:
<br />0 _19/2005. X `Ori "nal Contmuatiaa .,. } ;/ �•Ci- , ;.,
<br />pAYER�:N' M�'AWC1'; MAILING: ADDRESS::;.: a�''i`•:- , ";�'.�,,;.,:r;r_,;.r; `w����.:•
<br />BUSINESS NAME AND LOCATION A�DR1rSS' _TAX �! ;,•::. .:i.';
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<br />Name`•
<br />Business Name
<br />`r yet. usche:;, Lin �,..I:y.t,,:,r. :.f:..
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<br />Street Address- . Street ` or Other Ma ..._. „ : '?•:< .u,, .;.:,,�',:����.;. , rr >.<.; , .'Y ' . r . . .: S ta...t.Y. e>.: . .'�: .,. ! q� . . (:. ; °• . ,,..d.: ,i,
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<br />bate.bf ate►
<br />category., •Tax Pecind
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<br />1: ;:.g.., . •t• „: '
<br />Number ,,
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<br />0.91:'08/1 ':26:1 �., ..,. . „,,.:,:..- r.i -�,.. •,I
<br />4:24 '
<br />91200
<br />01'
<br />04
<br />n ��••,, ,,::”
<br />07/01/2004. - 5.04, 44..OT : ' -
<br />08/1912005 19 , , - "�, .;.,. �; �:.; = w:�:: .
<br />21 �. " a ,
<br />10/31/2004
<br />Please return to:
<br />STATE OF NEBRASKA
<br />DERkjr- MENT OF REVENUE
<br />1811 WEST eD ST STE 460 TOTAL $ 2,148.48
<br />GRAND ISLAND NE 68803
<br />I hereby certify that the Nebraska Department of Revenue has complied hashed the reve ue laws 6f
<br />the amount due the state of Nebraska f h s Notice of State has
<br />determination of,the amount shown to be due, and the taxpayer
<br />Tax Lren is an extension of effective lien, it serves to continue the priority of the -state's Interest in, the affected property of the taxpayer -6073
<br />Revenue Senior Agent
<br />sign p is Signatur
<br />�Tltle Date Teleph, ne Number �'
<br />here Revenue Supervisor e
<br />Title
<br />u arize S' na are 4-494-1974 Ra„• 2-2002 supersedes 4- 494-1974 Rev, 10 1995
<br />
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