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___93/10{2006 16:39 FAX 14024714429 NEBRASKA Dee Igj 007/007 2006'02149 1IIII1IIIII 9906442711-0 Pes. ~11~~~D~3~~~~gm~'12:51 PM Please Return Original Copy to the Nebraska Dept. of Revenue at 200 South Silber, North Platte, NE 69101 o~ lir IIr ll~ruJilo lIoPtitmliilt of~ NOTICE OF STATE TAX LIEN PLEASE DO NOT WRITE IN THIS SPACE This Notice of State Tax Lien is issued by the Nebraska Department of ,Revenue for unpaid taxes pursuant to the revenue laws of'the state of Nebraska. Notice is, hereby given that taxes including penalties and interest, which are shown below, are due from the taxpayer specified below and remain unpaid after demand. These taxes constitute a lien in the county for real and personal proper:tY belonging to the taxpayer or hereafter acquired. Nebraska Identification Number Federal Identification Number 36437778 Lien Serial Number Lien.Fited Wilh Social Secl!rity, N!Jmber ' Spouse's Social Security Number 40720062 ~ Register of Deeds OCounty Clerk 508~54-4961 " ,. , .' , - Date of Lien ;-r : lien, ~ype " County. ",- , , ., .: " i D co;rect~d I~ -: ~ . . ,". - ' .,-, 'j";'.' 03/07/2006', ' ~ Original 0 Co,ntinu~tion .~; :. . "HALL ' .'..;~. ..'~. .~ I ;::". -,'" " ,-- - , '" ' .- " ' "1" '," _H ..". ,.. I BUSINESS NAME AND LOCATION ADDRESS TAXPAYER NAME AND 'MAILING At>DRESS I Business Name Name GERALD L. RICHARDS Street Address Streel or Other Mailing Address 312 BROOKLINE DRIVE City State Zip Code City State Zip Code GRAND ISLAND NE 68802 I Tax 1 Category Tax Period Date of Amount of Tax Penalty Interest Additions Balance 9f Number ' Assessment Assessment Due 22 2001 01/26/2004 204~OO 10.20 52.05 266.25 " TOTAL, ~ 266.25 ..~-" "' - .. .. ~. . ", I hereby certify that the Nebraska Department of Revenue has complied with the revenue laws of the Slate of Nebraska in the 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 , , Tax lien ijfn extension ,of an :ffective lien, it serves to continue the priority of the slate's. interest in the affected property of the taxpayer. . ~ - , I.. 'U-"V' Revenue Agent/}-7.-{)1, , 308 535-8294 sign, Pr"sarer's igna Title Date Telephone Number , here .. Ju Revenue Supervisor 2" 7-D~ . '.,' Authorized Title 'Date' 'oD 4-484-1974 Ra\l. 2-2002 Suparsooda. 4-494-1974 Rey. 10-1995.,,\.: