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<br />02/01/2006 15:52 FAX 14024714429 <br /> <br />NEBRASKA Dee <br /> <br />141003 <br /> <br />{ <br />G\ <br /> <br />200600907 <br /> <br />1111111111' <br /> <br /> <br />990643494.-15 Pas. <br />~fI;~~O~19~~~2:0Ei 12:1111 PM <br /> <br />IIr <br /> <br />F1#a.sk;o <br />d~~i:1li\>Cll.l <br /><il"r.o"~"~ll <br /> <br /> <br />NOTI~--eF-STAIE-'TAX LIEN <br />U CC;jf . ~~,.~ Ip..1~J <br />04~ <br />o NOT WRITE IN THIS SPACE <br /> <br />I <br />This Notice of State Tax Lien is issued by the Nebraska O;epartment of <br />Revenue for unpaid taxes pursuant to the revenue laws ~f 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 constitute a lien <br />in the county for real and personal property belonging to:the taxpayer <br />or hereafter ae uired. <br />Nebraska Identification Number <br /> <br />FEideralldentification Number <br /> <br />39412024 <br /> <br />Lien Serial Number <br /> <br />Lien Filed With <br />[g] Register of Deeds 0 Co~nty Clerk <br />Lien Type <br />08/30/1996 0 Original [g} Continuation :. D Corrected <br />BUSINESS NAME AND LOCATION ADDRESS <br /> <br />Social Security Number <br /> <br />Spouse's Social Security Number <br /> <br />962430057 <br /> <br />476.78.8973 <br /> <br />Date of Lien <br /> <br />County <br />'HALL <br /> <br />TAXPAYER NAME AND MAILING ADDRESS <br /> <br />Business Name <br /> <br />Name <br /> <br />City <br /> <br />State <br /> <br />Zip Code <br /> <br />DOUG P PETERSON <br />St'reet or Other Mailing Address <br />-! 7909 MAPLE RIVER RD . <br />City <br /> <br />Street Address <br /> <br />BRUTUS <br /> <br />State <br />MI <br /> <br />Zip Code <br />49716 <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 />06/12/1996 <br /> <br />348.00 <br /> <br />17.40 <br /> <br />11.76 <br /> <br />377.16 <br /> <br />TOTAL <br /> <br />$ <br /> <br />377.16 <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 dl;Je after demand. If this Notice of State <br />Tax LIen is n extensi of an effective lien, it serves to continue the priority of the state's interest in the affected property of the taxpayer. <br /> <br />402 471-5928 <br /> <br /> <br />REVENUE AGENT <br />Title <br /> <br />\--~-,-o ~ <br />Date <br /> <br />sign ~ <br />here .... <br /> <br />REVENUE] SENIOR AGENT <br />Title <br /> <br />Telephone Number <br /> <br />/-ZO -a~ <br />Date rr <br />4-494--1974 Rev. 2-2.002. Supersede. 4-494-1974 RAV. '0-'995 '<.~ <br />