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05/10/2006 13:28 FAX 14024714429 NEBRASKA Dee 141 002 DeS rnIl~r,I![ 'I 9906451523-2 Pes, 1 SPITZ SAMUEL Filed; 05/03/2006 09:49 AM i ; 200604139 tr 'NOTICE OF STATE TAX LIEN 1.\~~1o;lo .oP4\itlrIJJ/I~ .;.f,I'i!l'~ PLEASE DO NOT WRITE IN nlls 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 an~ remain unpaid after demand. These taxes constitute a lien in the county for real and personal property belonging to the taxpayer or hereafter acquired. . Nebraska 'Identification Number Lien Filed With ~ocial Security Number Spouse's Social Security Number 9279822 ~ Register of Deeds D.county Clerik 505-08-2673 Lien Serial Number Lien Type Date of Lien County I~OIoOI~ rEI Original 0 Continuation o Corrected 04/25/2006 Hall I BUSINESS NAME AND LOCATION ADDRESS TAXPAYER NAME AND MAILING ADDRESS I Business Name ,- Name Samuel Spitz Street Address Street or Other Mailing Address PO Box 5611 City State Zip Code City State Zip Code Grand Island NE 68802 I Tax' I Category Tax Period Date of Amount of Tax Penalty Interest Additions Balance of "Number Assessment Assessment Due 01 1/1/04 thru 06/01/2005 835.bo 167.00 62.45 1,064.45 12/31/2004 21 1/1/04 thru 08/01/2005 1,045.00 261.25 77.13 1.383.38 12131/2004 TOTAL $ 2,447.83 I hereby certify that the Nebraska Department of Revenue has complied with the revenue laws of the State 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' an extension of an affective l1en, it serves to continue the priority of the state's interest in e affected property of the taxpayer. Revenue Senior AQent Title Revenue Senior Agent Title 402 471-5709 sign .... here II--