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<br />07/13/2006 16:22 FAX 14024714429 <br /> <br />NEBRASKA Dee <br /> <br />141 0021002 <br /> <br />\)~ <br /> <br />200606254 <br /> <br /> <br />.9906461227-6 _ Pg_, 1 <br />l.AINEZ I'\ARGARET <br />Fl1.d: 07/13/2008 11,66 A" <br /> <br />Please return to: <br />STATE OF NEBRASKA <br />DEPARTMENT OF REVENUE <br />1811 WEST 2ND ST 8TE 460 <br />GRAND ISLAND NE 68803 <br /> <br />If" <br /> <br /> <br />NOTICE OF STATE TAX LIEN <br /> <br />lIIeb,.~ <br />do,,_ <br />Of fO'l'tft\ltl <br /> <br /> PLEASE DO NOT WRITE IN nus 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 /> 9519343 ! <br />l:ien Serial Number Lien Filed With Social Security Number Spouse's Social Security Number, <br />t?J Olt1/ O()ICj- ~ Register of Deeds D County Clerk 505-78~7944 <br />Date of Lien Uen Type CounlY .. <br /> 07/11/2006 [!] Origin!!1 D.continuation o Corrected Hall <br />I BUSINESS NAME AND LOCATION ADDRESS TAXPAYER NAME AND MAILING ADDRESS I <br />Business Name Name <br /> Margaret Lainez <br />Street Address Street or Other Mailing Address <br /> 419 Roush Lane <br />City State Zip CO(je City State 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 />01 01/01/2004- 02/06/2006 2,041.50 143.33 129.78 2,314.61 <br />12/31/2005 <br />... _'_.r -. , ,- -, ~ -"." . .. - - '. _~ r __. TOTAL $ 2,314.61 <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 an extension an effective lien, it serves to continue the priority of the state's interest In the affected property 6f the taxpayer. <br /> <br />~;lI/J~J?~~ 308 385-6073 <br /> <br />Date . <br /> <br /> <br />Revenue Senior Agent <br />Title <br />Revenue Supervisor <br />Title <br /> <br />TelePhon~mber <br /> <br />D~!:; oa~ <br /> <br />- - ----" 4-494-1974 Rev. 2-2002 S,-,,""'edes 4-494-1974 R"".1D--1995 -\)V" <br /> <br />sign <br />here <br />