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<br />01/19/2006 16:08 FAX 14024714429 NEBRASKA Dee
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<br />~ 003/003
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<br />200600562
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<br />IIU1IIllor
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<br />
<br />l.EVINSON GORDON .
<br />Fil.d: 01/17/2006 03;05 PM
<br />Please Return Original Copy to the
<br />Nebraska Dept. of Revenue at 200
<br />South Silber, North Platte, NE
<br />69101
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<br />NOTICE OF STATE TAX LIEN
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<br />IIOpar\fMnoi
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<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 constitl.lte a lien
<br />in the county for real and personal property belonging to the tax,payer
<br />or hereafter acquired.
<br />Nebraska Identification Number Federalldentiflcatlon Number .. '
<br /> 38543540
<br />Lien Serial Number' Lien Filed With Social Security Number " . Spouse's'SociarSeClirity Number'
<br /> [g] Register of Deeds o County Clerk ' 'I T~
<br /> 953070073 508.60.1124 .- ' ' . .
<br /> , " , .
<br />Date of Lien Lien Type" , .. ' County." , . ~. - '
<br /> , ,
<br /> , 12114/1~95..: " o Origimil'.:[!]ConllnuaUon O'Correcled r , ,HAl.L ;,,'> '.', I . ~,._. '-
<br /> , .,-- ., -.. ~- .' ..- .'.' . . ...., . ".'-"
<br />I BUSINESS NAME AND LOGATION ADDRESS TAXPAYER NAME AND MAILING ADDRESS . " ..I
<br /> "."' ..
<br />Business Name Name
<br /> GORDON LEVINSON
<br />Street Address Street or other Mailing Address
<br /> 2315 SOUTH BLAINE ST
<br />City State Zip Code City State Zip Code
<br /> '. GRAND ISLAND NE 68801
<br />I Tax I
<br />Gategory Tax Period Date of Amount of Tax Penalty Interest Additions Balance of
<br />Number Assessment Assessment Due
<br />22 1984 10/03/1995 194.00 48.59 253.94 496.53
<br />22 1985 ' 10/0'3/1995 251.00 62.95 293.71 607.66
<br />22 1986 10/03/1995 239.78 59.95 246.14 ' 545.87
<br />22 1987 10/03/1995 361.00 90.25 319.81 771.06
<br /> 1988 THRU c
<br />~2 ..JOf03~ 1,041.00 290.25 707.96 2,009.21
<br /> 1989 ' , ,..,-."
<br /> ,~~~,' l'l~hlOl~ LK . tOTAL' , ,.~..,.,. $, 4,430.33 . ~ . ...-,.
<br /> ,'n. .. , U r.;;..: I f\ 1"'P'1'i ,..
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<br />sign ....
<br />h~re ....
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<br />I hereby certify that lhe Nebraska Department of Revenue has complied With the revenue laws of the State of Nebraska In the
<br />det~rmination of tne amount shown to be dl,Je, and lhe taxpayer has failed to pay the amount due after demand. If this Notice of State
<br />Tax L1en~ an extension of an effective lien, it serves to continue the priority of lhe state's interest in the affected property of the ta'xpayer,
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<br />- Revenue Agent / 1Z -;;lOOt:, 308 535.,82~4, '
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<br />Tille' Date T~6
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<br />Revenue Supervisor
<br />Tille
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<br />~l
<br />
<br />Dale
<br />+494-1974 Rev. 2.2002 Supersed..' 4-494-1974 Rev. 10-1995
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