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11/08/2005 16:59 FAX 14024714429 NEBRASKA Dee ~ 005/005 :"PJease retumto: , , STATE OF NEBRASKA; DEPARTMENT OF REVENUE 1811 WEST 2ND ST STE 460 'GItAND ISLAND NE 68803 111"'11111111 99054218174-1 pgs: 1 I"E lNECKE BEVER!. Y Filad: 11/07/200S 11:47 AM .~ 200511105 '" NOTICE-OF STATE TAX LIEN llelll,.ro. dopalitl\Mil\ of~ PLEASE DO NOT WRITE IN THIS SPACE This Notice of State Tax Lien is issued by the Nebraska Department of Revenue for unpaid taxes pursuant to the ,revenue laws of the state of , Nebraska. Notice is hereby given that taxes including penalties and interest, which are shown below, are due from the taxpayer specified below and remain unpaid after demand. These taxes constitute a lien in the county for real and personal property belonging to the taxpayer or hereafter acquired. Nebraska Identification Number Fedaralldentification Number 9141480 Lien Serial Number Lien Filed With Social Security Number Spouse's Social Security Number D'S Ill/~4'lD" ' ,[!] Register of Deeds o County Clerk 505-64-2423 Date of Lien .. r, ". ' :"Uen Type County , ' I '.' t1l03/2005.;' " ' IE] Original D Continuation o Corrected Hall I BUSINESS NAME AND LOCATION ADDRESS TAXPAYER NAME AND MAILING ADDRESS I Business Name Name Beverly Meinecke' Street Address Street or Other Mailing Address 611 Howard Avenue City State Zip Code City State Zip Code St Paul NE 68873 I Tax I Category Tax Period Date of Amount of Tax Penalty Interest Additions Balance of Number Assessment Assessment Due 01 08/01/2005- 11/03/2005 . 591.98 59.20 3.79 654.97 08/31/2005 01 09/01/2005- 11/03/2005 621.71 62.17 0.92 684.80 09/30/2005 21 01/01/2004- 07/30/2005 300.00' 75.00 13.61 388.61 12/31/2004 -,' . -' TOTAL $ 1,728_38 I hereby certify that the Nebraska Department of Revenue has complied with the revenue laws of the State of Nebraska in the 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 Tax Lien is an extenslo~n f an effective lien, it serves to continue the priority of the state's interest in the affected property of the taxpayer, p II ---: / 'I ...- . ... ("":\ '\..!.L-- . . Revenue Senior Agent 1./ J () 6 308 385-6073 sign Preparer's Signature 'Tille Dale Telephone Number here ... Revenue Supervisor 11/04/2005 T~ D~ 4-.494-1974 Rev. 2-2002 supersede. 4-494-1974 Rev. 10.1995 0" . " . ' \lJ