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<br />03/10/2006 16:38 FAX 14024714429 <br /> <br />NEBRASKA Dee <br /> <br />141 006/007 <br /> <br />200602148 <br /> <br />III""'" <br /> <br /> <br />991/1&442111/1...a <br />THOMpScI ONe" s/H1~~gtl12 : 41 .P!'\ <br />Fila: ~. <br /> <br />tfi <br /> <br />Please Return Original Copy to the <br />Nebrask<l Dept. of Revenue at 200 <br />South Silber, North Platte, NE <br />69101 <br /> <br />ar <br /> <br />NOTICE OF STATE TAX LIEN' <br /> <br />flllbtflSjO. <br />d_*,'M <br />l)f.~ <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 unpaid taxes pursuant to the revenue laws of the state of <br />Nebraska. Notice'ls hereby given that taxes including penalties and <br />interest, which are shown below, are due from the taxpayer speclfi.ed <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 Idenlification Number Federalldenliflcalion Number <br />j. 38257920' <br /> . ,,,.,', <br />Lien Serial Number Lien Filed With Social Securlly Number Spouse's Social Security Number <br />. .- '.' 40090336 . rID Register of Deeds' o Counly Cler:\< 508w02-4570 " .. <br /> ,. <br />Date of Lien " lien Type " Count,~; -:- ;~,": ,: ",' '\' <br />. ..~" . , I~lorigj~al D Continu~tion o Corrected .." ,... -.. ' , . . ~.. , ,- .,. - <br /> 03/07/2006 HALL " <br /> " <br />r BUSINESS NAME AND LOCATION ADDRESS TAXPAYER NAME AND MAILING ADDRESS' ' .." I <br />Business Name Name <br /> SHANNON R. THOMPSON <br />Street Address Street or Other Mailing Address <br /> 913 W S FRONT 5T <br />City State Zip Code Cily State Zip Code <br /> GRAND ISLAND NE . 68801 ' <br />~ Tax I <br />Category Tax Period Date of Amount of Tax Penalty Interest Additions Balance of <br />Number Assessment Assessment Due <br />22 2002 06/03/2003 255.95 47.10 92.03 395.08 <br /> , <br /> ,. ", <br /> TOTAL $ 395.08 <br /> <br />, sig'n' ... <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 lhis Notice of State <br />Tax Lien' an extension of an effe~tive lien, it serves to continue the priority of the state's interest in the affected property of the taxpayer. <br /> <br />Revenue Agent 3-1-tJ (, 308 535~8294 <br /> <br />ille Date Telephone Number <br /> <br />Revenue SupelVisor .5 - 7-() (;; , . ' <br /> <br />TOe ....-m..... ,..", .,::~, --"" 'w_ ,."" ~D <br /> <br /> <br />