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<br />09/05/2006 16:49 FAX 14024714429
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<br />NEBRASKA Dee
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<br />~ 0021003
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<br />Please retum to:
<br />STATE OF NEBRASKA
<br />DEPARTMENT OF REVENUE
<br />1811 WEST 2ND ST STE 460 .
<br />GRAND ISLAND NE 68803
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<br />200607951
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<br />9906468101-9 Pgll: 1
<br />MATSON JAMES A
<br />Filed: 09/06/2006 BB;25 AM
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<br />NOTICE 9F STATE TAX LIEN
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<br /> PLEASE DO NOT WRITE IN THIS 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 t~e taxpayer
<br />or hereafter acauired.
<br />Nebraska Identification Number Federal Identification Number
<br /> 9235906 .
<br />Lien Serial Number , Lien Filed With Social Security Number Spouse's Social Security Number
<br /> . OP:,\ nl.lJ nn ~f1 o Register of Deeds D County Clerk 507 86 7740
<br />Dale of Lien ~ Lien Type County
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<br /> . 08/3,1/26ci~:' o O'rigin~l D co'ntin.Llaiiof." .'" o ~o.r,rec~ed,', . --. Hall: ., , , -. . , --
<br /> : ,,- . ,
<br />I ... BUSINESS .NAME AND:.LOCATION'APDRESS'. -. - '-'. " I"" : : ,T~PAy'ER NAME:,ANDMAI~ING ADDRESS ,." I
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<br />Business Name Name , . ,,'1 '.~ ~ ",. . ". _". .. " . .. --. , ..
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<br /> . '.) ~ ,. , .
<br /> ,- - .~,.. -- , ,........, ,James A Matson ,. ;
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<br />Street Address Street or Other Mailing Address
<br /> 30.90. W Second Street
<br />City State Zip Code City Stale Zip Code
<br /> Grand Island NE 68803
<br />I T~x I
<br />Category Tax Period Date of Amount of Tax Penalty Interest Additions Balan!;e of
<br />Number Assessment Assessment Due
<br /> 0.1 06/01/200.4- 07/05/200.6 '8,397.15 1,0.17.52 607.81' 10,022.48
<br /> 0.3/31/20.0.6
<br /> 21 0.1/05/2004- 02111/2005 483.74 190.30 10.5.69 779.73
<br /> 12/31/2004
<br /> 21 0.1/0.1/2005- 0.3/28/2006 2,244.95 363.0.7 148.30 2,756.32
<br /> 12/31/20.05
<br /> 21 0.1/01/2006- 06/27/20.06 -0- 9,62 1.88 11.50
<br /> 03/31/2006
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<br /> , - . 'j., TOTAL $ 13,.570.03
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<br /> ~ .,- . - ,~- ~. . ... ._,"
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<br />.. _ I hereby certify lhalthe Nebra$~a 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 ha,s' failed to 'pay.the amo'unt due-BrtElf ,demand. 'If.this Notic!" of..~,tat~ . .
<br />. Tax Lien' is an extension of n effective Ii n. it serves to continue'the priority of the state's interest in .the affected property of the taxpayer. .
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<br />.::_:"-'~-'-' p-. ~ -,.. -,.- .,-,....'. Revenue Senior At:\ent 'q/J/~OOIa ____ - 30.8385-6073
<br />sign Prep rer's Signat e Title Date' Tele~h n~umber
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<br />here .. Revenue Supervisor ~~
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<br />4-494-1974 Rev. 2-2002 SuptI'.Bd.. ~!04-1914 Rev '0-1995
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