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<br />05/12/2006 16:06 FAX 140247~4429 <br /> <br />NEBRASKA Dee <br /> <br />141 004/004 <br /> <br />200604232 <br /> <br />'I lrl l:I'-ll I 11,'1 <br /> <br />9906453141-4 Pes: 1 <br />MANIVONG PHOUKHAM <br />Filed, 05/1212006 02:36 PM <br /> <br />iJi <br /> <br />IIr <br /> <br /> <br />NOTICE OF STATE TAX LIEN <br /> <br />"",bro...;> <br />cl.~F:lFi>Ol1; <br />Q1' r'O"'~l1.V <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 <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 aCQuired. <br />Nebraska Identification Number Federal Identification Number <br /> 35751231 <br />Lien Serial Number Lien Filed With Social Security Number Spouse's Social Security Number <br /> 43170046 IKl Register of Deeds o County Clerk ' 413~35-2044 <br />Date of Lien Lien Type County <br /> 05/04/2006 IKl Original D Continuation o Corrected HALL <br />r BUSINESS NAME AND LOCATION ADDRESS TAXPAYER NAME AND MAILING ADDRESS 1 <br />Business Name Name <br /> ~ PHOUKHAM MANIVONG <br />Street Address Street or Other Mailing Address <br /> 7079 FIGHTER DR UNIT 1101 <br />City State Zip Code City State Zip Code <br /> ELMENDORF AFB AK 99506 <br />I Tax 1 <br />Category Tax period Date of Amount of Tax Penalty Interest Additions Balance of <br />Number Assessment Assessment Due <br />22 2001 q /2.8/ Df 382.00 19.10 101.10 502.20 <br /> . <br /> I <br /> , TOTAL $ 502.20 <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 />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 <br />Tax Lien is n extenslo of an effective lien, it serves to continue the priority of the state's interest in the affected property of the taxpayer. <br /> <br />~ REVENUE AGENT '.rL t..f /OCo 402 471-5928 <br /> <br />sign .,. Title D Ie ' , Telephone Number <br /> <br />-here .. REVENUE SENIOR AGENT :\-, -'I-ok rf' <br /> <br />Title Date \i1 . <br />4-494-1974 R.... 2.2002 Supersede. 4-494-1974 Rev 10-1995 '\1-':"-- <br /> <br /> <br />