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<br />01/19/2006 16:08 FAX 14024714429 <br /> <br />NEBRASKA Dee <br /> <br />141 002/003 <br /> <br />\)~ <br /> <br /> <br />200600561 <br /> <br />9906432880-5 Pas: 1 <br />LEVINSON GORDON <br />F1,~d: 01/17'2m06 03:05 PM <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 />~ <br /> <br />NOTICE Q,F STATE TAX LIEN <br /> <br />rlCIlrll$~ <br />dD"itll\Nl1 <br />of .... <br /> <br /> PLEASE DO NOT WRITE IN THIS SPACE,' <br />This Notice of State Tax Uen 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 incl'udlng 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 acquired. <br />Nebraska Identification Number Federal Identification Number <br /> 38543540 <br />Lien Serial Number Lien Filed With, Social Security Number Spouse's Social Security Number <br /> ,953070071 ~ Regist_er of De,eds o County Clerk ~08~0~ 1 ~ 24 . - ' - <br /> .. <br />Date of Lien Lien Type County <br /> D Original ~ Continualio~ ' o Corrected ,.. " <br /> 12/14/1995 ' HALL' ., , ,-, .' ~'" " <br />r BUSINESS NAME AND LOCATION ADDRESS TAXPAYER NAME AND MAILING ADDRESS I <br />Business Name- Name <br /> GORDON LEVINSON <br />Street Address Streel or Other Mailing Address <br /> 2315 SOUTH BLAINE ST <br />City State ZIp Code City Stale Zip Code <br /> GRAND ISLAND NE 66801 <br />I Tax 1 <br />Category Tax Period Date of Amount of Tax Penalty Interest Additions Balance of <br />Number Assessment Assessment Due <br />22 1990 09/19/1995 632.00 ,158.00 294.46 1,084.46 <br />22 1991 09/19/1995 170.00 42.50 55.34 267.84 <br /> Utt~. .< [lli%IO I~t q ) " - -, <br /> ''',' -, <br /> Co4t ,9b':101 ~ Lq ! TOTAL $ 1,352.30 <br /> , <br /> <br />I hereby certify that the Nebraska Department of Revenue has complied With the revenue lawso,f the State of Nebraska In the <br />determination of the amount shown to be due, and the taxpayer has failed to pay the amount dU~ after demand. ,If this Notice of State <br />Tax Lien is n extension of an effective lien. it serves to continue the priority of the state's interest in the affected property of the taxpayer. <br /> <br />_ c?AC)..--,--:- Revenue Agent /)/2....200(, 308 535-8294 <br /> <br />sign ,... P parer' Sign ure TItle , DalE! ' TetePhoneNu"?~" <br /> <br />here... ~ Revenue Supervisor /-/;;2;',t) b <br /> <br />T~ D~ , <br />4-494-1974 Rev, 2-2002 SuperlledU 4-"94-1974 R~v_-10-1985 <br /> <br /> <br />~D <br />