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11/02/2006 16:47 FAX 14024714429 NEBRASKA UCC 1002/003 <br />NR iwe of 94 *49 John A dale - YCC GTL <br />V <br />.2-00609871 HALL 784 Z L7 Pas :, <br />Filed: 1i/02120M 02:48 PM <br />Please Return Original Copy to the <br />Nebraska Dept. of Revenue at 200 <br />South Silber, North Platte, NE <br />69101 <br />Or <br />dpPpelnwFG1 <br />Qf r>k1'4i1W�i� <br />NOTICE OF STATE TAX LIEN <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 the taxpayer <br />or hereafter acquired. <br />Nebraska Identification Number Federal Identification Number <br />38012960 <br />Lien Serial Number Lien Filed With Social Security Number Spouse's Social Security Number <br />60D60169 :. f�egister of Deeds' [] County Clerk 505 -84- 113Iµ' <br />Date of.Lien Lien Type .. County.: . <br />Original 'QCo'rtifluation' ,QCorrected; <br />:`HALL' <br />�,. _ <br />BUSINESS NAME AND LOCATION ADDRESS TAXPAYER NAME AND MAILING ADDRESS <br />Business Name rvernc . . - <br />SHERRY L. HALL <br />Street Address Street or Other Mailing Address <br />227 SO VINE STREET <br />city State Zip Code City State Zip Code <br />GRAND ISLAND NE 68801 - <br />Tax <br />Category Tax-Period Date of Amount of Tax Penalty Interest Additions Balance <br />a nce Due <br />Number Assessment <br />22 2000 04/24/2005 333.20 16.66 127.81 477.67 <br />22 2001 04/24/2005 .288.00 14.40 84.56 3861.96 <br />TOTAL = $ - . 864,63 <br />I hereby.certify that•khe 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 />Taz Lien i n extension of an effective lien, it serves to continue the priority of the state's interest in the affected property of the taxpayer. <br />Revenue Agent pho 535 -8294 ' <br />5111:: .UAut' 'nature Title Date ;••- ,Telephone - Number,_: <br />here Revenue Su ervisor <br />Title Date <br />4-194 -1874 Rev. 2 -2002 Supersedes 4-494 -1974 Rev. 10 -198 <br />