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<br />06/02/2006 16:11 FAX,14024714429
<br />
<br />NEBRASKA Dee
<br />
<br />~002
<br />
<br />200604991
<br />
<br />'l'Ill ill 'II III If 1'1
<br />
<br />
<br />9906455714-1 PSI: 1
<br />WHEELER TROV L ' ' ,
<br />Filed: 0610212006 03:26 PM
<br />
<br />Please Return Original Copy to the
<br />Nebraska Dept. of Revenue at 200
<br />South Silber, North Platte, NE
<br />69101
<br />
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<br />
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<br />
<br />NOTICE OF STATE 'TAX LIEN
<br />
<br />PLEASE DO NOT WRITE IN THIS SPACE
<br />
<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 ttie,state,~f
<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 Numl:ler Federal Identification Number
<br />
<br />-.- 29678935-" '-'. ,
<br />
<br />Lien Serial Number Lien Filed With Social Security Number S.~ouse's Social seciJrity'Nuinber
<br />':,:.:,:~,,51:~3q,1!4~~;;:!,', <~.,';,>,;" ~R~Q'isie/Ofp~~dS:".-Dc.~unty Clerk " ,.. ?07;'02'~379~ - "'. _" , ,.-
<br />Date of Lie;L,:' -:. "Ci,,~,..,.';. ;~'_' ...,0. . . '_ Deri. TyP!! - -'" " ".,"- " "",, Cou.nty" ':.... : '" ..': . . ",,-:
<br />, . q5/31/200? ,: '" [KI Qriginai 0 Conti,nUBtlon D Corrected HALL - ;:
<br />BUSINESS NAME AND LOCATION ADDRESS TAXPAYER NAM,E AND MAILING ADDRESS
<br />
<br />1
<br />
<br />I
<br />
<br />Street Address
<br />
<br />Name
<br />TROY L WHEELER
<br />Street or Other Mailing Address
<br />2222 SELLWOOD DR
<br />
<br />Business Name
<br />
<br />GRAND ISLAND
<br />
<br />APT 87
<br />State
<br />NE
<br />
<br />I Tax,
<br />CategolY
<br />Number
<br />
<br />Tax Period
<br />
<br />Date of
<br />Assessment
<br />
<br />~mount of Tax
<br />
<br />Penalty
<br />
<br />Interest
<br />
<br />Additions
<br />
<br />Zip Code
<br />68801
<br />
<br />Balance of 1
<br />Assessment Due I
<br />
<br />Cit~
<br />
<br />State
<br />
<br />Zip Code
<br />
<br />City
<br />
<br />22
<br />
<br />2002
<br />
<br />04/25/2005
<br />
<br />743.22
<br />
<br />67.60
<br />
<br />217.48
<br />
<br />1,028.30
<br />
<br />TOTAL
<br />
<br />$
<br />
<br />,1,028.30
<br />
<br />'_ I hereby certify that the Nebraska Department of Revenue has.complied with the revenue laws of the State _of Nebra~~a. in the .".-
<br />determination of.the amount shown to be due, and the taxpayer has failed to pay the amount du~ after demand, If this Notice of State
<br />Tax lien i an eXtemsion of an effective lien, it serves io continue the priority of the state's -interest In 'the affected property of the taxpayer,
<br />
<br />. ". - <' ],' ' .. 'Revenue Agent '-5>3/-'0(;' - - 308 535'~a'294'" .
<br />
<br />sign .. I Tille Date' Telephone Number '
<br />
<br />here' Revenue Senior A!=)ent ,5"-31--06. t",
<br />
<br />Title , -4-"lEl~-1S7-4 Rav_ 2-2002 SU~.~::des 4-49-4'1874 Rev. 10.1995 ~y
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