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12/18/2003 <br />09:C7 FAX 14024'14429 NEBRASKA UCC <br />r <br />'JOCIaI SeCurit Number <br />Co un Ciirk 505 -52 -3010 <br />tY � <br />Spouse's Social Security Numbe. <br />. <br />508 -54 -8592 <br />Ir <br />,J! <br />1 <br />Da 12/1212003 <br />- -- - _H. - <br />County <br />all <br />Please return ta: <br />TAXPAYER NAME AND MAILING ADDRESS <br />STATE OF NEBRASKA <br />DEPARTIvlBNT OF REVENUE <br />1811 WEST 2 "D ST STE 460 <br />GRAND ISLAND NE 68803 <br />or <br />City <br />ftor"Ito <br />City State <br />Grand Island NE <br />Zip Code <br />68801 <br />Tax <br />Category <br />( Number <br />olftvfts <br />Date of <br />Assessment <br />Z003/003 <br />20031614 i`y! <br />NOTICE OF STATE TAX LIEN <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 specifiers <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 />• <br />Nebraska Ident�7 a ion Numb <br />T6'10905"er <br />XeRe t "s eWof Deeds <br />gi � <br />0 ❑ <br />r <br />'JOCIaI SeCurit Number <br />Co un Ciirk 505 -52 -3010 <br />tY � <br />Spouse's Social Security Numbe. <br />. <br />508 -54 -8592 <br />Lien S �ri N tuber <br />� Orig nal � Continuaton Q Corrected <br />Da 12/1212003 <br />- -- - _H. - <br />County <br />all <br />BUSINESS NAME AND LOCATION ADDRESS <br />TAXPAYER NAME AND MAILING ADDRESS <br />Disiness Name <br />Name <br />Jerry L & Caroie L Denton <br />Street Address <br />_ <br />Street or Other Mailing Address <br />205 S Cedar <br />City <br />State Zip Coce <br />City State <br />Grand Island NE <br />Zip Code <br />68801 <br />Tax <br />Category <br />( Number <br />_ <br />Tex Period <br />Date of <br />Assessment <br />Amount of Tax <br />Penalty <br />Interest <br />Additions <br />Balance of <br />Assessment Due <br />22 <br />1999 <br />03127/2001 <br />1,408.00 <br />352.00 <br />496.70 <br />2,256.70 <br />22 <br />2000 <br />03112/2002 <br />2,602.00 <br />734.50 <br />683.71 <br />1 <br />4,020.21 <br />22 <br />2001 <br />1/112/2002 <br />2,339.00 <br />358.90 <br />259.91 <br />2,957.91 <br />TOTAL . <br />$ . 9.234.72 <br />I hereby cerfify that the Ni Department of Revenue has comphed with the revenue laws of the -State of Nebraska it the <br />determinatian'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 Lie aair a sion of an 7eUc,�%v/e en, it serves to con5nue the priority of the state's interest In t�hee afffected property of the taxpayer. �_ TSS' 1J "U 308 385-6067 <br />AA <br />sign Preparer's Signature _ Title Date Telephone Number <br />here Revenue Supervisor /®? n <br />Authoriz a '�'�— Title Da <br />4_494.1974 Rev. 2.-x02 3u raedes�9a -1974 pay. 10 -1995 <br />