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<br />10/11/2006 15: 11 FAX 14024714429 <br /> <br />NEBRASKA Dee <br /> <br />~ 0021002 <br /> <br />,E\, . <br /> <br /> <br />D ---. - -,_.- ~----'---"'- -----~~, <br /> <br />200609105 <br /> <br />-II'JIII"'JllIl-,- <br /> <br />9906474532-8 Pilli' 1 <br />BURRIS GRRY <br />Filed, 10/11/2008 02:21 P" <br /> <br />'" <br /> <br /> <br />NOTICE OF STATE TAX LIEN <br /> <br />~ilibt;1S~ <br />iOIlpa~ <br /><<--- <br /> <br /> " PLEASE DO NOT WRITE IN THIS SPACE <br />This NotiC?e 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 givon that taxes including penalties and <br />interost, ,!"hich are shown below, are due from the taxpayer specified <br />below and remain unpaid after demand. Theso taxes constituto a lien <br />in tho county for real and porsonal property belonging to the taxpayer <br />or hereafter aCJlulred. <br />Nebraska IdentffiCC!tion Number Lien Filed With ' Social Security Number Spouse's Social Security Number <br /> 5443687 [g] Register Of Deeds D, County Clerk 512-42-7018 <br />Lien Serial Number Lien Type Date of Lien County <br />I ~ O()4, ~ 3 LI.;1.. [E] Originai 0 Continuation o Corrected 09/22/2006 Hall <br />I' BUSINESS NAME AND LOCATION ADDRESS - TAXPAYER NAME AND MAILING ADDRESS I <br />Busin~ Name Name <br /> Gary Burris <br />Street Address , Street or Other Mailing Address <br /> 2021 N Sherman <br />City State , Zip Code City State Zip Code <br /> Grand Island NE 68801 <br />~ Tax I <br />Category Tax Period Date of Amount of Tax Penalty Interest Additions. Balance of <br />Number Assessment Assessment Due <br />01 1/01/2004 thr 08/01/2005 300.00 60.00 29.84 - 389.84 <br />12/31 i2004 <br />01 1/01/2005 thr 08/01/2006 375.00 75.00 14.79 464.79 <br />12/31/2005 . <br />21 1/01/2004 thr 09/15/2006 382.89 95.72 38.21 516.82 <br />12/31/2004 <br />21 1/01/2005 thr 08/11/2006 375.21 93.80 14.43 483.44 <br />12/31/2005 <br /> TOTAL $ 1,854.89 <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 extensi~n of an effective lien, It serves to continue the priority of the state's Intezr' st in the affected property of the taxpayer. <br /> <br />. . Revenue Senior Agent ~j511Jb 402 471-5709 <br />sIgn ~ p, ....s. Tltie . a" T~eph? ~U~b" <br /> <br />here ",. Revenue Senior Agent, J fI.iP/ tJ..b <br />Title Date <br />4-494-1974 Rev. 2-2002 Supersedes 4-494-1974 Rev. 10.1995 r,{' <br />f.,v <br /> <br /> <br />