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08/06/2003 09:34 FAX 14024714429 NEBRASKA UCC Q002/003 <br />is <br />?leve atom to: <br />STATE OF NEBRASKA <br />DEPARTAUNT OF REVENUE <br />1821 WEST 2ND ST STE 460 <br />GRAND ISLAND NE 68803 <br />200310266 <br />Na aK.,t..» u4 M <br />I <br />III �i C 111111 <br />eMIS-1 Pas: 1 <br />t90NnIR Rt�p� <br />FLIs 0a /A6rZ007 64:06 PM <br />Or NOTICE OF STATE TAX LIEN <br />.ftmro <br />OltWrhaLCP <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 law's of the state of <br />Neb.aska. 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 />.J <br />V, 4'.. 6Y1LFl YV W <br />Nebraska Identificatior Number <br />7965067 <br />Lien Filed With <br />Q Re Star of Deeds <br />❑ County Clerk <br />Socia Security Number <br />507 -78 -8107 <br />Spouse's Social Security Number <br />Lien Se al IN In <br />Jr <br />Lien Type <br />1K Original ❑Cortinuation 'Idorreoted <br />I Date of Lien <br />i 07/24/2003 <br />County/ <br />Hall <br />I BUSINESS NAME AND LOCOORADDRESS <br />TAXPAYER NAME AND MAILING ADDRESS <br />Business Name <br />Name <br />Rhonda J McNair <br />Street ?adress <br />Stress or Other Mailing Address <br />701 West State Street <br />City State Zip Cone <br />City <br />Grand Island <br />State Zip Code <br />NE 66803 <br />ax <br />Category <br />Number <br />Tax Period <br />Data of <br />Assessment <br />Amount of Tax <br />Penalty <br />Interest <br />Additions Balance of <br />Assessment Due <br />0 <br />01r'0112001 <br />12/3112002 <br />07!24!2003 <br />350.00 <br />70.00 <br />10.37 <br />430.37 <br />V <br />01/01/2002 <br />03!31)2003 <br />07/2412003 <br />419.41 <br />137.50 <br />19.66 <br />576.57 <br />TOTAL <br />$ 1,005.94 <br />hereby certify that the Nebraska Department of Revenue has complied with the revenue laws of the Stara of Nebraska in the �� <br />datetminaUon of the amouni shown to be due. and the tayrpayar has failed to pay the amount due after demand. If tors Notice of State <br />lax Lien is a xtensio n effective lien., it serve to oontirure the priority of the state's interest in the affectao property of the taxpayer. <br />308 385 -607 <br />Revenue Senior <br />Anent �— /1 <br />Sign ure a ate 7alep one Number r <br />hers Revenue Supervisor <br />rized !g f TIUe D <br />4-0eF1974 r6v. Z -2002 e�o.rs.def 9- 4f0•!9 ?G R. ip -1996 <br />