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06/14/2006 15:46 FAX 14024714429 ., - C11 'f"\v \j IIr nllbra:ska department of reven ue NEBRASKA Dee 141 002 , 1 'f' 200605321 Filed: ::/1 Pg,; 1 . 4/2006 12:43 PM Please Return Oliginal Copy to the Nebraska Dept. of Revenue at 200 South Silber, North Platte, NE 69101 ,Notice -of state Tax Lien PLEASE DO NOT WRITE IN THIS SPACE INDIVIDUAL INCOME TAX soc. SEC. NO. NEBR. IDENT. NO. SPOUSE SOC. SEC. NO. TAXABLE YEAR LIEN NO. COUNTY DATE OF NOTICE DATE OF ASSESSMENT 505984464 30511348 2004 052450335 HALL 09/02/2005 06/14/2005 ROSE FUSS ~ PO BOX 101 CAIRO NE 68824 THIS NOTICE OF STATE TAX LIEN IS ISSUED BY THE NEBRASKA DEPARTMENT OF REVENUE FOR INDIVIDUAL INCOME TAX PURSUANT TO THE REVENUE LAWS OF THE STATE OF NEBRASKA. NOTICE IS HEREBY GIVEN THAT INDIVIDUAL INCOME TAXES INCLUDING PENALTIES AND INTEREST, WHICH ARE SHOWN BELOW ARE DUE FROM THE TAXPAYER SPECIFIED ABOVE AND REMAIN UNPAID AFTER DEMAND. THESE TAXES CONSTITUTE A LIEN 'IN THE COUNTY FOR PROPERTY BELONGING TO THE TAXPAYER OR HEREAFTER ACQUIRED. AMOUNT OF TAX. . . . . . . . . . . . . 1,077.00 PENALTY . . -. .-. . ': . . ~...,. . .. 53.85 INTEREST (COMPUTED TO 09/02/2005) . 24.79 TOTAL AMOUNT DUE . . . . . . . . 1,155.64 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, ~ND THE TAXPAYER HAS FAILED TO PAY THE AMOUNT DUE AFTER DEMAND_ IF THIS NOTICE OF STATE TAX LIEN IS AN EXTENSION OF AN EFFECTIVE LIEN IT SERVES TO CONTINUE THE PRIORITY OF THE STATE'S 'INTEREST IN THE'AFFECTEDPROPERTY OF THE TAXPAYER. t.~7:<J~ ~00r)s3S:-f.27t DATE/~~~EPHONE . ..~~...-- DATE _~ IIT15 1(1104 ' ~~.....- T~"..."...