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<br />08/21/2006 16:55 FAX 14024714429
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<br />NEBRASKA Dee
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<br />~ 003/005
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<br />11111111'1
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<br />UTHlll" BENJA/'IIN G.
<br />Flied: 08/21/2006 09:5& AM
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<br />200607482
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<br />Please Return Original Copy to the
<br />Nebraska Dept. of Revenue at 200
<br />South Silber, North Platte, NE
<br />6910'1 '
<br />
<br />Ir
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<br />NOTICE OF STATE TAX LIEN
<br />
<br />Il~'-
<br />d4ptitm.....
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<br /> PLEASE DO NOT WRITE IN THIS SPACE
<br />This,Notice of State Tax Lien is Issued ~y the Nebraska Department of
<br />Revenue for unpaid taxes pursuant to the revenue laws of the state of
<br />N,ebrask__. Notice is hereby given that taxes including penalties and
<br />interest, which are shown below, are due from ihe taxpayer specified
<br />below and reniain 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 />Nel?raska ,Identincation Number Federalldentlf1cation Number
<br /> 43032508
<br />Lien Serial Number Lien Filed With Social Security Number Spouse's' Sociall:;,ecui"ity Number
<br /> I!l,liegi~ter of Deeds . 0 Co~ntY Clerk 506-43-6199 " . ,.
<br /> 40930090"" -,' , . .. --
<br /> l.k'.I;.~" . :~ :~.'I.l:,~ f -t"::~?I'Yl~:.-'~' I.:i'-.-r\~ '..~ ,- - ' , .. .'. .
<br />Date of ~iel) ,'.- . _l...,: .,\":' ~ ..,-., . -lJen"!)pe" . ' ' . " County. ,. ',. ".t-_' -- '::,1' .
<br /> - " - .
<br /> 06/1;572006 . . ~ bri9:i~~1 0 Continuation -- .', .- ., "
<br /> , '-~~;' . "'-"1:1""~ -:. 1 D c;orrect~d HALL.,. " ,,' "
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<br />I '. :BUSIN!=~~-,N~E,AND LOCATlO~ ADDRESS TAXPAYER NAME AND MAILING ADDRESS r
<br />Business Name Name ,..". -- ., . .
<br /> BENJAMIN G. UTHUM
<br />street Aqdress '. Street or Other Mailing Address
<br /> -- 619 N WASHINGTON 8T APT 5
<br />.., . .
<br />City State Zip Code City State Zip Code
<br /> LEXINGTON NE 66850
<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- 2002 02/17/2004 143.00 9.35 27.97 180.32
<br /> "
<br /> -- -TOTAL. 0 $- 180.32
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<br />here'
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<br />,. - I hereby7certify thai the Nebraska Department of Revenue has complied with Ihe revenue laws of the:Stale of Nebraska In the
<br />delermination of the amount shown to be due, and the taxpayer has failed to pay the amount due after demand. If this Notice of Stale
<br />~ Tax Ueri"i . an' e:id:ensi n of effective-lien; II-serves to continue the priority ofthe state's.interest in the affected prope~ tlf th_e.!llXPayeL . _ _ .
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<br />- Revenue Agent SJ~/t,.(Jt 308 535-8294
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<br />Title Date - Telephone Number-
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<br />Revenue Supervisor S:-/7-(:)6
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<br />Title - Date. .' ,\\
<br />4-494-1974 Rev, 2-2002 supelHdes 4-494-1974 Rev, 10-1996 Qu
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