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<br />02/24/2006 15:33 FAX 14024714429 <br /> <br />NEBRASKA Dee <br /> <br />~ 004/006 <br /> <br />200601665 <br /> <br /> <br />ST~ <br /> <br />bb. <br /> <br />9906439253-3 p .' 1 <br />PRICE ALLEN H 8', <br />Filed: 02/17/2008 02:54 PM <br /> <br />Please Return Original Copy to the <br />Nebraska Dept. of Revenue .at 200 <br />South Silber, North Platte, NB <br />69101 . <br /> <br />'r <br />MIIiWll(a. , <br />.~' <br />of~ <br />; . <br /> <br /> <br />NOTICE OF STATE TAX LIEN <br /> <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 Linpaid 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 constitute a lie.n <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 /> 36346586 <br />Lien Serial Number Lien Filed With Social Security Number Spouse's Social Security Number <br /> 5'1890337 lK1 Regi'~ter of Deeds' o CountY Clerk ' ". ..- .... u.. ..... <br /> 515-68M2291 . . <br /> -- , <br />Date of Lien ; Lien Type ~County . " <br /> . ., [g]Originai 0 C;;ntlnu~ti~~ - .' :. D.corr~Cled. HALL . ,,-. <br /> 02/15/2006.: .\ '. . .. <br /> ,. ..;:-: ,'!'I:'- .. <br />I BUSINESS NAME AND LOCATION ADDRESS " TAXPAYER NAME AND MAILlN'G ADDRESS'. . "l <br />Business Name Name <br /> ALLEN H. PRICE <br />Street Address Street or Other Mailing Address <br /> 1015 W 9TH <br />City State Zip Code City State Zip Code <br /> GRAND ISLAND NE 68801 <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 2000 09/23/2003 1,104.92 55.25 377.70 1,537.87 <br />22 2001 11/11/2004 520.00 26.00 130.95 676.95 <br />22 2002 05/12/2005 693.00 34.65 . 118.13 845.78 <br /> TOTAL . . $. ~.060.60 . <br /> <br />~i~1\ lJl> <br />here ... <br /> <br />I hereby certify that the Nebraska Department of Revenue has complied with the revenue laws 01 the State of Nepraska in the' <br />determination or the amount shown to be due, and the taxpayer has failed to pay the amount due after demand. 11 this Notice of State . <br />Tax Lien is e~ension of an effective .I~en. it serves .to .continue the priC!~ of the state's interest in the affected property of the taxpayer. <br /> <br />-. . Revenue Agent ;Jli~06 -- . - ... .' .. 308 '535~B294 <br /> <br />Tille Date ..' .: . " . . Telephone Number ',:'C <br /> <br />Revenue Supervisor . -- .. -. -.. . - .. ";::?~/J-;"i?6'" -. <br /> <br />~ ~ d <br />4-494-1914 Rev, 2-2002 Suplrsede. 4-494-1974 Rlv. 10--1995 ~:l <br /> <br />