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<br />02/01/2~06 15:52 FAX 14024714429 <br /> <br />NEBRASKA Dee <br /> <br />IaI 002 <br /> <br />~ <br />G <br /> <br />200600906 <br /> <br /> <br />I) <br />IIr <br /> <br /> <br />NOTICE,-O~.,S:r.AJE TAX LIEN <br />lAtct:1)9-q ~IO '112,~ <br />N . '1lo - J 0 y..S <br />PLEASE DO NOT WRITE IN THIS SPACE <br /> <br />...(!,br:l,P;~ <br />d.p.I!'l<i>cEl~ <br />Ql'f~,...j:"'Il<i <br /> <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 attar demand. These taxes constitute a lien <br />in the county for real and personal property belonging to the taxpayer <br />or hereafter acuired. <br />Nebraska Identification Number Federal Identification Number <br />39353370 <br /> <br />962290024 <br /> <br />Social Security Number <br />305~54-2268 <br /> <br />Spouse's Social Security Number <br /> <br />Lien Serial Number <br /> <br />Lien Filed With <br />[I Register of Deeds D County Clerk <br />Lien Type <br />08/16/1996 0 Original [j Continuation <br />BUSINESS NAME AND LOCATION ADDRESS <br /> <br />o Corrected <br /> <br />County <br />HALL <br /> <br />Date of Lien <br /> <br />TAXPAYER NAME AND MAILING ADDRESS <br /> <br />Street Address <br /> <br />Name <br />RONALD L LbvELL <br />Street or Other Mailing Address <br />1830 W MORRIS ST <br /> <br />Business Name <br /> <br />INDIANAPOLIS <br /> <br />State <br />IN <br /> <br />Zip Code <br />46221 <br /> <br />City <br /> <br />State <br /> <br />Zip Code ' City <br /> <br />Tax <br />, Category Tax Period <br />Number <br /> <br />Date of <br />Assessment <br /> <br />Amount of Tax <br /> <br />Penalty <br /> <br />Interest <br /> <br />Additions <br /> <br />Balance of <br />Assessment Due <br /> <br />22 <br /> <br />1995 <br /> <br />OS/29/1996 ' <br /> <br />269.00 <br /> <br />13.45 <br /> <br />:8.16 <br /> <br />290.61 <br /> <br />TOTAL <br /> <br />$ <br /> <br />290.61 <br /> <br />sign ... <br />here .... <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 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 />REVENUE AGENT -1,-I,-{)y 402471-5928 <br /> <br />Title Dale Telephone Number <br /> <br />REVENUE SENIOR AGENT / -::l1J - c>~ <br /> <br />Title 4494-1974 Rev. ;-2002 SU~~::de. 4494-1974 R&v.1Q-1995 ~ \' <br /> <br />