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NEBRASKA Dee IgJ 003/005 12/23/2005 17:06 FAX 14024714429 I;)~ IIr nebra ska department of revenue STL P91l' 1 200512570 Please Return Original Copy to the Nebraska Dept. of Revenue at 200 South Silber, North Platte, NE 69101 Notice of state Tax Lien PLEASE DO NOT WRITE IN THIS SPACE INDIVIDUAL INCOME TAX SOC. SEC. NO. NEBR. I DENT . NO. SPOUSE SOC. SEC. NO. TAXABLE YEAR ,LIEN NO. COUNTY DATE OF NOTICE DATE OF ASSESSMENT ' 505709724 12009385 2004 052450275 HALL 09/02/2005 06/14/2005 68803 R JAMES SMITH 1823 WEST 3RD GRAND ISLAND NE THIS NOTICE OF STATE TAX LIEN IS ISSUED BY THE NEBRASKA DEPARTMENT OF REVENUE FOR INDIVIDUAL INCOME TAX PURSUANT TO THE REVENUE LAWS OF THE STATE OF NEBRASKA. NOTICE IS HEREBY GIVEN THAT INDIVIDUAL INCOME ' TAXES INCLUDING PENALTIES AND INTEREST, WHICH ARE SHOWN BELOW ARE DUE FROM THE TAXPAYER SPECIFIED ABOVE AND REMAIN UNPAID AFTER DEMAND. THESE TAXES CONSTITUTE A L1EN IN THE COUNTY' FOR PROPERTY BELONGING TO THE TAXPAYER OR HEREAFTER ACQUIRED'. AMOUNT OF TAX . . . . . . . . . . . . '234.00 PENALTY . . . . . . . . . . . . 11.70 INTEREST (COMPUTED TO 09/02/2005) 5.39 TOTAL AMOUNT DUE . . . . . . . . 251.09 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 EXTENSION-_OF AN EFFECTIVE LIEN IT SERVES TO CONTINUE THE PRIORITY OF THE STATEIS INTEREST IN THE AFFECTED PROPERTY OF THE TAXPAYER. kt:.cJ~. ~P~E~~~T~ . ~zrn s~ '~.~'.'... lfTLE ~ tfL.;:I- I!<~....... .~tr:.... TITLE P-/9!! ?/G.'?)53$:a:~9'-1 DATE/TELEPHONE . . . !~.~(1.--.t!.~. DATE . IfNS 101D4~