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<br />10/25/2006 17:14 FAX 14024714429 NEBRASKA Dee 14J 002/002
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<br /> 200609528 9916476908-1 j'
<br /> ~T'iD JON D. 3IlI M --'
<br /> Fll_d: 10.'~~/~006 11: .-~
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<br /> Please Return Original Copy to the
<br /> Nebraska Dept. of Revenue at 200
<br /> South Silper, North Platte, NE
<br /> 6910 1
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<br />NOTICE OF 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. Nl)tice is hereby given that taxes including penalties a,nd
<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 the ta~payer
<br /> or hereafter acquired.
<br /> Nebraska Identification Number Federal Identification Number
<br /> 32553749
<br /> Lien Serial Number .,-' n " Lien Fi!ed With Social Security Number ,.. -", .. Spouse's Social-SeCuritY Number .,
<br /> . ,", _ , 534.79.0.1 ~>__ "",:1,.,':,: '(" .': l~lF-~~,~.t~[,,~,tD~~,!~ - 0 Cl)l!nty CI,erk 505-74-5915 508.;84-27'33
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<br /> D,at~,,~~-.~~~_~"~;;,:~~/d~fib:6~ :,i_; ':'~;;'~:: "t;;:~ ;':' ~.; . ~i~f]);rYPft-' ~.< . :{ :,: ;{ ".: ',' " __:.1' ,', ,C!OUr,lty-;. ':, . ,,';;-- .j' . ..\ r'.~: ~. :...,!i'; ~~
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<br />1-.. ' '--' B'-'~UNI;S.$ ~;u.,E. A~.o ~9C~ Ti6~ ADp_RE~S, T~AYER NAME ,AND MAILING ADDRESS' , . I.
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<br /> Business Name Name
<br /> JON D. -& KAREN K. HALLSTED
<br /> Street Address Street or OtherMailing Address'
<br /> 1620 W JOHN STREET
<br /> City State Zip Code City - State Zip Code
<br /> GRAND ISLAND NE 68801
<br />I Tax 1
<br />Category Tax Period Date of Amount of Tax Penalty Interest Additions Balance of
<br />Number Assessment Assessment Due
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<br /> 22 2004 0~/24/2005 885.00 217.00 86.76 1,188.76
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<br /> ,- " -- -.; -- iOTAL $- ,. 1,188.76 :
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<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' an e.Jlt~nsioii' of an effeellv8 'lien, it, S'~rves to-c~lntinue the priority of the state's interest i~ the affected property of the taxpay~r. ' -,-'"
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<br />sign
<br />here ...
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<br />, !O-23-fO'
<br />Date
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<br />308 535-8294
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<br />Revenue Supervisor
<br />Title
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<br />Telephone Number
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<br />m ...:2:!,.-06
<br />"Date
<br />-4--4!M.1974 R"v, 2-2002 SupB~&5 4-494-1974 Rev_ 10.1995 ~
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