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<br />07/07/2006 16:05 FAX 14024714429
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<br />NEBRASKA Dee
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<br />1aI 002/002
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<br />200606102
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<br />1111111'1111'111 '
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<br />9116481389..7 PIiII: 1
<br />~ENGFELDER DAVID E
<br />r Filed: 0711712016 19:27 ~
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<br />Please Return Original Copy to the
<br />Nebraska Dept. of Revenue at ZOO
<br />South Silber, North Platte, NE
<br />69101
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<br />NOTICE OF STATE TAX. LIEN
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<br /> PLEASE DO NOT WRITE IN THIS SPACE
<br />This Notice o( State Tax, Lien is Issued by the Nebraska Department of
<br />Revenue for unpaid taxes pursuant to the rev-enue Jaws of the ,state .of ,"
<br />_.~"e>>ras~~J~.9..~i~~ J!J:I~eJ~y_gi!!~ntl@t ~~es _1~clu~~mL P_~~~J~!~~_!I)~ u - .. -.- -- .~ '" .--- - - -- - - ,- - - - --- . ---
<br />Interest, which are shown below, are due from the taxpayer specified
<br /> . .
<br />below, and remain unpaid after demand. These taxes constitute a lien
<br />in the coullty for real and personal property belonging to the taxpayer
<br />or. hereafter acquired.
<br />Nebraska Identification Number Federal Identification Number
<br />- .40397491 ' -",
<br />Lien Serial Num~,r, ",' ,_ " .' Lle~ File~ With , ",.. ' .Social Secl.!r1ty,Nurnber Spouse'~ Social Security Number
<br />1~J.~egist~r'~f'.~~~ ..,0 County, Cler:k " .-
<br /> . : ..5,1'61:0'018"",..,:..: ",'''''' ' 329-46~9699
<br />,'.1'; _'~'" 'I~~",""'~i::\': .,.~.". :__"~"~'''''-l./ . _ ,n. ". . .,- I ~....." .. ... f' .
<br />..,p'~~e of,qen, '.' ',<,i.>". :''\:.;''.1;.... :' :.:'r'\:~;:.~I:.,:.,.:~.r! '::.Uen~'TYpe. ': ,:,~ :';:': ".', '.. ..' ' ,County " ' .. ...--, . .. . .-
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<br /> 07/osiiooe'i [~l~ri,~i~~1 0 Continuation " ,0 POrrected ','.' . ' . ' '.
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<br />I BUSINESS. NAME AND LOCATION,ADDRESS, TAXPAYER NAME AND MAILING ADDRESS I
<br />Business Name Name " .' .....
<br /> DAVID E LENGFELDER
<br />Street Address Street or Other Mailing Address
<br /> 1109 W 9TH 5T
<br />City State Zip Code City State Zip Code
<br /> GRAND ISLAND NE 66801
<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 200i' 04/25/2005 246,00 12.30 47.59 305.69
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<br /> " "" ~~~'I~~- " . ~. .' . ~ : ~. . :,~
<br /> . , -,--..-,-"..' -- -- , . - -,' - ,,' '-' .' ......,
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<br /> " TOTAL $ 305.89
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<br />, ,:... '. I:.herebyu~,~!fy thl!lt the Nepraska ,C1eparlment ,of, Reven ue has complied with the revenue laws of the State,of Nebraska in the' , , '
<br />determlnatiCln ofthe amounl'shown to .be due,.and the taxpayer ha$failed to 'pay the amount due after demand, Ifthis Notice of State
<br />T,~ Lien 'j n extension of an effeclive,l!eri.,I\ s~lYes to continue the priority of the state's interest in the affected property of the taxpayer. .-
<br />.. .. ',;, , ' ' ,7:.oc- /)/ 308,535-8294
<br />... RevenUe Agent _ !Z.--L/<.P
<br />sign Title Date Telephone Number
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<br />here. ... Revenue Senior Agent ' 7 - ~l) -Ob
<br />Tille Date Q
<br />4-~94-19~. Flev, 2-2002 Super..d.... ~-494-197'" Rev, 10-1995
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