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<br />11/lB/200j 16:47 FAX 14024714429 <br /> <br />NEBRASKA Dee <br /> <br />Igj 0021003 <br /> <br />" <br /> <br />~' <br />CJ <br /> <br />1111111"" · <br /> <br /> <br />9905422763-3 Pgl. , <br />STUTZl'\RN RosERT E, <br />Fil_d: 11/1712005 10:43 R~ <br /> <br />200511486 <br /> <br />Please Return Original Copy to the <br />Nebraska Dept. of Revenue at 200 <br />South Silber, North Platte, NE <br />69101 <br /> <br />Ir <br /> <br /> <br />NOTICE OF STATE TAX LIEN <br /> <br />rt*~I$~ <br />~p\\dJM&Il <br />of~ <br /> <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 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 />or hereafter acauired. <br />Nebraska Identification Number Federal Identification Number <br /> 39475727 <br />Lien Serial Number Lien Filed With Social Security Number Spouse's Social Security Number <br /> 4'1560055 ~ Register of Deeds , 0 County Clerk 501-82-0885 <br />Date of Lien ,Lien Type, County, .. " <br /> " <br /> 11/15/2005 '[2S] Original 0 Continuation '0 Corrected . Hall, ,.".' <br /> -. . ~ . ,,- .. <br />I BUSINESS NAME AND LOCATION ADDRESS TAXPAYER NAME AND MAILING ADDRESS I <br />Business Name Name <br /> Robert E. stutzman <br />Street Address Street or Other Mailing Address <br /> 507 S Sycamore <br />City State Zip Code City State Zip Code <br /> 'Cairo NE 68824 <br />~ Tax I <br />Category Tax Period Date of Amount of Tax Penalty Interest Additions Balance of <br />Number Assessment Assessment Due <br />22 2000 04/15/2004 91.00 22,75 29.99 143.74 <br />22 2001 07/30/2004 11.00 2.75 2.62 16.37 <br />22 2002 07/30/2004 ' 5.00 1.25 0.79 7,.04 <br /> TOTAL $ 167.15 <br /> <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 i an extension of an effective lien, it serves to continue the priority of the state's interest in the affected property of the lal(payer:' <br /> <br />308 535-8294 <br /> <br /> <br />Revenue Agent <br />TItle <br /> <br />Revenue Senior AQent <br />Title <br /> <br />/I-IS ~ r:; <br />Date <br /> <br />..' <br />sign <br />here ~ <br /> <br />Telephone Number <br />/f-IS.-tJ5' <br /> <br />Date <br />4-'194.1974 Rov.2.2002 Supersedes 4-494-1974 Rev, 10-1995 <br /> <br />9f' <br />,.- J <br />