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08/28/2006 13:16 FAX 14024714429 ~ IIr nebraska d.pilr1menl of revenue NEBRASKA Dee ~ 003/006 .' NI 18" ..f "... J_ II a.l. . lICe In ", .'.&467185-2 PilI: 1 SEBESTA GERALD A Flled: 01'2112006 09,41 ~ 200607722 Please Return Original 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 SOC. SEC. NO. NEBR. IDENT. NO. SPOUSE soc. SEC. NO. TAXABLE YEAR LIEN NO. COUNTY DATE OF NOTICE DATE OF ASSESSMENT INDIVIDUAL INCOME TAX 507909825 25079727 2002 052450548 HALL 09/02/2005 07/19/2005 GERALD A SEBESTA 508 1/2 S ADAMS GRAND ISLAND NE 68801 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 . . . . . . . . . . _ . . . . 617.59 PENALTY . . . . . . . . . . . . . . . . . . . .. 40.55 INTEREST (COMPUTED TO 09/02/2005) . . . . . . .. 100.42 TOTAL AMOUNT DUE . . . . . . . . . . . . . . .. 758.56 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, AND 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 AFFECTED PROPERTY OF THE TAXPAYER. h[.cJ~.. P)lEPARER'S ~ ~4tk- ........ AUTHORIZED SIGNATURE ~.~....... TITLE T~'~:"""""" f :/lJ -;Q~/ 6t)&i3s - .3J..9+ DATE/TELEPHONE l?~.3 ~ ...................... DATE GP liTIS 10104