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08/28/2006 13:17 FAX 14024714429 \)~ IIr I'lR"~ dO,.I1",*" Of rfrvOtMI NEBRASKA Dee Igj 004/006 .r 980I4G1B81-1 Pili: 1 DUBBS MARV Filed: 08/28/2008 09:41 A" 200607723 Please Return Original Copy to the Nebraska Dept. of Revenue at 200 South Silber, North Platte, NE 69101 PLEASE DO NOT WRITE IN THIS SPACE This Notice of State Tax Lien Is Issued by the Nebraska Department of Revenue for unpaid taxes pursuant to t"e revenue laws of the.state of Nebraska,. Notice Is hereby given that taxes Including penalties and interest, which are shown below, are due from the taxpayer specified below and remain unpaid after demand. These taxes constitute a lien in the county for real and personal property belonging to the taxpayer or hereafter acquired. Nebraska Identification Number Federalldentificalion Number 44979460 Lien Serial Number Lien Filed With Social Security Number Spouse's Social Security Number 600601~5. I!l Register. of, Deads D County Clerk 505-52-6920 " Date of Lien ' , , Lien Type County - , 08/24l2006 IKl Original D Continuation ' D Corrected HALL , , I BUSINE;SS NAME AND LOCATION ADDRESS TAXPAYER NAME AND MAILING ADDRESS I Busin.ess Name Name MARY DUBBS Street Address Street or Other Mailing Address 412 E 9TH City State Zip Code City State Zip Code GRAND ISLAND NE 68801 I Tax I Category Tax Period Date of Amount of Tax Penalty Interest AddlUons Balance of Number Assessment Assessment Due _. 22 1999 04/24/2005 141.27 7.06 65.42 213.75. 22 2000 04/24/2005 131.43 6.57 49.03 187.03 22 2001 04/24/2006 164.45 8.22 46.55 219.22 TOTAL $ 620.00 NOTICE OF STATE TAX LIEN 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. Ifthi5 Notice of State n extension of an effective lien, it serves to continue the priority of the state's Interest in the affected property of the taxpayer. - Revenue Agent Jl.;ll/-4)(". ,3peI.5_35;'8294 Title Date Telephone Number Revenue Supervisor .?'-OI c.j~ Trtle Date .....~-197. Rev, 2.2002 Supe'....dGl.-<49<4-HI74 Rev. 1o--199(]p ,sign ~ here ...