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<br />04/20/2006 15;57 FAX 14024714429 <br /> <br />NEBRASKA Dee <br /> <br />~ 012/012 <br /> <br />~ <br /> <br />200603552 <br /> <br /> <br />, \G <br />VD <br /> <br />Please Return Original Copy to the <br />Nebraska Dept. of Revenue at 200 <br />South Silber, North Platte, NE <br />69101 <br /> <br />_r <br /> <br />NOTICE OF STATE TAX LIEN <br /> <br />f101:0i';l$/Q. <br />--~ <br />ot~, <br /> <br />PLEASE DO NOT WRITE IN THIS SPACE <br /> <br />This Notic~ of State Tax Lie~is issued by,the Nebraska Department of <br />- Revenue,for unpaid taxes pursuant to the'revenue laws aU he 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 lien <br />In the county for real and personal property belonging to the taxpayer <br />or hereafter acaulred. ' <br />Nebraska Identification Number Faderalldentlficalion Number <br />43243266 <br /> <br />;~iei] Serial Num~~r, " Lien FiI~d VVith ' , Social Security.N~r:nber , Spouse's Social Security Number. <br />4261 0179!K1 Regist,er of D~eds' 0 County Clerk 508-86-7292' ::.: '" ',' <br />Date of Lien ;'''_''_''"L'!-'" ,"LienTyp's", "', ..",_", ,'Count(~': '.. .. '_ <br />.. . :'_ ;:04/17/20~6;' ;.--:, ,;' ,',' IKl O~iglnal:'[]COntl~uati~'~" . ,DC~rr~cted, ", ":_: 8all_,:~c .. :_:>,;:',.~" -- '" '_ " .. ..... --... ""--~..... <br />I BUSINESS NAME AND LOCATION ADDRESS- TAXPAYER NAME'AND MAILING ADDRESS' 1 <br /> <br />"'Business Name - <br /> <br />Name <br />, Susan A. Lantzer <br />Street' or Other Mailing Address <br />903 S. Oak <br /> <br />, Street Address <br /> <br />22 <br /> <br />2003' <br /> <br />07/02/2004 <br /> <br />606.00 <br /> <br />30.30 <br /> <br />73.02 <br /> <br />State Zip Code <br />Ne 68801 <br />Additions Balance of I <br /> Assessment Due <br /> 412.78 <br /> 709.32 <br /> <br />City <br /> <br />State <br /> <br />Zip Code <br /> <br />City <br /> <br />_Grand Island <br /> <br />I Tax <br />Category <br />Number <br /> <br />Tax Period <br /> <br />Date of <br />Assessment <br /> <br />Amount of Tax <br /> <br />Penalty <br /> <br />Interest <br /> <br />22 <br /> <br />2002' <br /> <br />04/25/2005 <br /> <br />35Q.00 <br /> <br />'17.50 <br /> <br />45.28 <br /> <br />-T9TA.I,..';::~;',.' $', ,':..1.,,122.1.9 <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 />determinaf n of the amount shown to be 'due, and the taxpayer has failed to pay the amount due after demand, If this Notice of State <br />, Tax Li~~ I eXtens~on of active lie ,it serves to continue the priority of the state's interest in the affected property of the taxpayer" <br />, - <br />308 535-8306 <br /> <br /> <br />04/17/2006 <br />Date <br /> <br />'Telephone'Number . <br /> <br />04/17/2006 . <br />Date [('\\ <br />4-494-1974 Rev. 2-2002 supersede. 4-494-1974 Rev, 10-1995 \y <br /> <br />. ... <br />SI~l,n" . <br />here ... <br /> <br />Revenue Supervisor. <br />Title <br /> <br />,p- <br /> <br />i - <br />