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<br />N~,BRASKA Dee <br /> <br />141 004/004 <br /> <br />04/10/2006 17:10 FAX 14024714429 <br /> <br />\)~ <br /> <br />111111""'11 I <br /> <br /> <br />L90l'lIS KIMBERLY A PgS' 1 ~ <br />~11.d: 04/10/2006 02:48 PM ,; <br /> <br />200603143 <br /> <br />'r <br /> <br />NOTICE OF STATE TAX LIEN <br /> <br />ll.~~ <br />.,.$nQII\ <br />oI,.1i.t <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 Please forward to: <br />Nebraska. Notice Is hereby given that taxes including pena'lties and Nebraska Dept of Revenue <br />Interest, which are shown below, are due from the taxpayer specified 4500 Ave I PO Box 1500 <br />below and remain unpaid after demand. These taxes constitute a lien Scottsbluff, NE 69363'-1500 <br />in the county for real and personal property belonging to the taxpayer <br />or hereafter' acauired. <br />Nebraska Identificalion Number Federalldentlficalion Number <br /> ," ' .. <br /> '8739811 , " J' " <br /> '-. - " "' .. ' ' <br />Lien, Serial Number ' ~ Lie'n Filed With Social Security Number '..' . Spouse's Social Security Number <br />.. u .,,,... .' ~-2()06-001 0 ., " ~ Register of Deeds D County Clerk ' 506-02-4592 '. 505-84~!:!273' <br />Date of Lien Lien Type County <br /> 00 Original D Continuation , <br /> 04/05/2006 o CoiTected Hall ' , <br />I BUSINESS NAME AND LOCATION ADDRESS TAXPAYER NAME AND MAIUNG ADDRESS -I <br />Business Name Name <br /> Kimberly A & Scott A Loomis <br />Street Address Street or Other Mailing Address <br /> 2310 West Oklahoma Ave <br />City State Zip Code City St~te Zip Code <br /> Grand Island NE 68803 <br />I Tax I <br />Category Tax Period Date ,of Amount of Tax Penalty Interest Additions Balance of <br />Number Assessment Assessment Due <br /> 21 J1/01/03 thru 07/28/2005 1,362.00 , 340.50 -134.57 1,637.07 <br /> 12/3112004 <br />- <br /> .., ," <br /> . . .., . TOTAL $ 1,837.07 <br /> , <br /> <br />sign' .... <br />here .... <br /> <br />, ,I hereby',certify that the Nebraska Departme f Revenue has complied with the'revenue laws of the Stale of Nebraska in -the .' <br />determination of the a ount sh n to.be d";r and the taxpayer, has failed to pay the amount due after demand. If this Notlce of State <br />Tax Lien is ext ion 0 ffactive I 0t serves to continue tt)e priority of the stale's interest in the affe ted property of the taxpayer. <br /> <br />~~.~ 308632~1200 <br /> <br />Telephone Numb <br />a {j5fijb, <br /> <br />Date' . <br />4-494-1974 Rev. 2-2002 supersod"-" 4-494-1974 Rev. 10-199( <br /> <br /> <br />Revenue Supervisor <br />Title <br /> <br />ReVenue Supervisor <br />Title <br /> <br /> <br />QI <br />