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<br />11/18/2005 16:48 FAX 14024714429 <br /> <br />NEBRASKA Dee <br /> <br />~ 003/003 <br /> <br />~ <br /> <br />~-~- - <br /> <br /> <br /> <br /> <br />\11"11\\111\ <br /> <br /> <br /> <br />99054%%773-4 Pel. 1 \' <br />STUTZI'IAN ROBERT E. : <br />Filed, 11/17/2005 10,48 AM _ _._..._j <br />_ . .,_,_ _ __ ____.__...............-.-~.n"....y~--- <br /> <br />200511487 <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 />'r <br />_r/il~ <br />Gtllllitl'M~' <br />~t~ <br /> <br />NOTICE OF STATE TAX LIEN <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 arid 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 />Nebraska Identification Number Federal Identification Number <br /> 39475727 - <br />Lien Serial Number lien Filed With Soc;ial Security Number Spouse's Social Security Number <br /> 41560056 ~,Register of Deeds o County Clerk 507-62-0885 <br />Date of Lien Lien Type County <br /> 11/15/2005 ~ Original D Continuation o 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 />r Tax I <br />Category Tax Period Date of Amount of Tax Penalty Interest Additions Balance of <br />Number Assessment, Assessment Due <br />22 1996 041t5/2004 565:00 ' 153.25 418.64 1,136.B9 <br />22 1997 04/15/2004 630.00 157.50 377.85 1,165.35 <br />22 1998 04/15/2004 334.00 83.50 170.26 587.76 <br />22' 1999 04/15/2004. 72.00 18.00 30.20 120.20 <br /> ,. TOTAL, $ 3,010.20 <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 Notic;e of State <br />Tax Lien ,i&; an extension of an !;.ffedive lieri, it serves to continue the priority of the state's interest in the affected property of the taxpayer. <br /> <br />. ... '1' 1... " 1 Revenue Agent i I-l)~:;' 308 535-8294 <br />sign Parer's Sign . ---f--- Tille Date T;~ePhog Number ' . <br /> <br />here ... ,/~ Revenue Senior Aqent a-I - OS- <br />. ~ '~D <br />4-'194.1974 Rev. 2.2002 SupGr.ed.. 4-494-1974 Rev. 10-1995 t <br /> <br />