|
<br />06/21/2006 16:26 FAX 14024714429
<br />
<br />NEBRASK~A Dee
<br />
<br />Igj 004/004
<br />
<br />I
<br />~~
<br />
<br />
<br />9906458061-9 PlIS' 1
<br />CRUMRINE TYLER 6, .
<br />Filed: 06/21/2006 10:49 AM
<br />
<br />20060-5569
<br />
<br />Please Return Original Copy to the
<br />Nebraska Dept. of Revenue at 2'00
<br />South Silber, North Platte, NE
<br />69101
<br />
<br />at
<br />
<br />
<br />NOTICE OF STATE TAX LIEN
<br />
<br />rllltt3KIo
<br />1I0\1llrtl't1lb!\l
<br />of~,
<br />
<br /> '- PLEASE DO NOT WRITE IN THIS SPACE
<br />This Notice of State Tax Lien ,is issued by, the ~ebras_ka, Department of
<br />R~we"ue for unpaid taxes pursuant to the revenue laws of the state of
<br />Nebraska., Notice is her~by given that taxes including penalties and
<br />interest, which are shown below, are due from the taxpayer specified
<br />b,elow 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 Idenlificalion Number Federal Identification Number
<br /> -99581477- ' .
<br /> "
<br />Lien Serial Number Lien Filed With Social Security Number , Spouse's Social Security Number
<br /> 4-:<1.; 4C}"(')'31.'\, -- ~ "Re.giste~ of_ Deeds _ _ D ~ounty. Clerk' " ,,~08-23-71131 '
<br />, .'. . :' , ~', I" .,. :'-."~".,. ,.: ,~'.~. ... '. ,'. , ,..
<br />._.. ,I.' .' " ,t ,. . h - I' I. . '-'J- " 1'-'
<br />Date oLLien.... ' , ' " >LieriTYpe. -- , . " County -
<br />-,'.' -, . '".' .." , \.:.~! . .:; --- ' .
<br />., ' ,-- ~ . -, 00 Original 0 Continuation
<br /> 06/16/2006 o Corrected Hall
<br />r BUSINESS NAME AND LOCATION ADDRESS TAXPAYER NAME AND MAILING ADDRESS I
<br /> , -
<br />, Business Name Name
<br /> Tyler G., Crumrine
<br />Street Address Street or Other Mailing Address
<br /> 817 N. Gunbarrel Road
<br />City State Zip Code City .Stale Zip Code
<br /> Grand Island NE 68801
<br />I Tax I
<br />Category Tax Period Date of Amount of Tax Penalty Interest Additions Balance of
<br />Number Assessment Assessment Due
<br />22 2003' 06/16/2004 305.00 45.25 59.95 410.20
<br />.__.n - . .,.~.- , --.------ -., .__.__._n ... -- -.-- - . .~__ - ~___,__." n._ ___ , -.- -- -- ~.. , ,. - ~ .. ~_._~. .. ._ .__. ~u, . ---~_. ....., . ...-- - n_ __. ..-.-- - .- -
<br /> .--- .,-
<br /> ,
<br />" , " ,
<br /> , . TOTAL $ 410.20
<br />
<br />1 hereby certify that the NebraskaDepartmen~ of Revenue has complied with the revenl,le laws pf,the Stall;!. of N.e~raska in lhe ,
<br />'determln' i l)-'~f t,heamoLinl shown tobe<due, and th~ taxpayer has,failed to pay the amount due after demand. If lhis Notice of State
<br />Tax Lien's n -e:densii?n of . ctive lien, i erves to continue lhe priority of the stale's interest in the affected property of the taxpayer.
<br />
<br />308 535~8306
<br />
<br />
<br />Authorized Signature
<br />
<br />Revenue Aqent
<br />Tille
<br />Revenue Supervisor
<br />Tille
<br />
<br />06/16/2006 .
<br />Date -
<br />
<br />Telephone Number
<br />
<br />06/16/2006 " , "
<br />Date (') r
<br />4-0194-1974 Rev. 2-2002 Sup..rs~d~s 4-494--1974' Rev, 10-1995 _ _ ~_ k
<br />
<br />sign ..
<br />here ..
<br />
|