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<br />04/19/2006 08:38 FAX 14024714429
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<br />NEBRASKA Dee
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<br />141 007/007
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<br />Notice of State Tax Lien
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<br />, .' '.', ; ..' ,~--''i!-'~ c..,", il.. : .,..,."~,,, .', .~ <<ti _ .;" .... ".~..1 P~PO).NOT)NRI~I~,fTHI~!:\PAPIL.., . r .'
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<br />This Notice .:.r-State',Tax'Lien isis~ued"bj'the"N~brasb Depart~ent of . ,.:-:> '.... ,. "t' ,
<br />Rnenue for unpaid taxes pursuant to the revenue laws of the state of ~ , .,:: . .'
<br />Nebraska. NotiCe is bereby given that taxes including penalties and, ."
<br />interest, whicb are shown below. are due from the taxpayer specified '. : ,',', .:.
<br />below and remain unpaid after demand. These taxes constitute a Uen 10 ','
<br />the county for real and personal property belonging to the taxpayer,or
<br />hereafter acquired. "
<br />Nebraska ldentific:allon Number UerI Filed Wilh ," Social Security or Federal 1.0. Number ' Spouse's Social Security Number
<br />5 2: 500 51 Register of DeEicts 0 coUnty Clerk'" 3 '
<br />Usn Serial Number Uen Type
<br />7/09 317 Qr:iglnal 0 Contin~tion ' 0' COrrected
<br />BUSINESS NAME AND LOCAnON ADDRESS
<br />BuslJ)ess Name
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<br />County
<br />. 9-10-97 HALL
<br />TAXPAVER NAME AND MAIUNG ADDRESS
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<br />Name
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<br />OAK GROVE INN ;".
<br />street AddrllSS
<br />3205 SOUTH LOCOST
<br />City - State
<br />GRAND ISLAND NE 68802
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<br />. TSAK, COR?
<br />Street or Qthe( MalMng Address
<br />2421 E' SKELLY"DRI VB.
<br />City Slate
<br />TULSA ox 74105
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<br />STE 110
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<br />Zip COdIl
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<br />Zip COde
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<br />ax Date of Balance of
<br />Cl1tegory , Tax Period ,Amount ofTu . Penalty Interest Additlona
<br />Number Assessment Assessi,:nent Due
<br /> 11-01-9&-
<br />01 ..23 148..82 89..40 1126..45'
<br />01 I 1 '53' ..'93.' ,49'..3k. : ; 61,1.02
<br /> 30..15,
<br />21 .1"
<br /> 569..19 82.82 48..61 5..00 705..-62'
<br />21' O. 0 14.76 3..09 d' . 1 7 ."6 5-
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<br />68 7.90 34.21 .4~2..17.'
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<br /> 5-08- .' '"1 2045.89 365.85 14l\..46 2560.20
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<br /> TOT A,L' $ 566*_31
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<br />I hereby certiIy lhat the Nebraska Department of Revenu,e has complied with ihe revenue liIws of the Slate of Nebraslai in the detenninatiO!l
<br />of tile amount shown to be due, and thuixpayer has failed to pay the amount due after demand. If thIs Notice of State Tax Usn is an eJrtension of
<br />an aff~e f~~ continue the priority of ~e slaw's inter~ in the affecled propQ~of the taXpayer.' ,.~. '
<br />sign ' ':4' -;.'i' ~:,,'f ~ . < /.il. 19 /.,' ;,:.. -- '....'.
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<br />here PI' s-Sf{j'natufe - _./,1 l1lI~? ;/ Date . , TllI~ ~~ ..
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<br />NEBRASKA DEPARTMENT- OF REVENUE _ White and Goldenrod Copies TAXPAYER - Pink Copy COUNlY OFFICE - Canary Copy
<br />@",..... an ""')dod _ ' ' ' +-494-74 AtN.. 10-95 s...pIIR8dBs ~74 FIBv. 5-115
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