<br />11/15/2006 17:00 FAX 14024714429
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<br />NEBRASKA uee
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<br />raJ 0021002
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<br />200610243
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<br />Please return to;
<br />STATEOFNEBRASKA .
<br />DEPARTMENT OF REVENUE
<br />18'11 WEST 2ND ST STE 460
<br />GRAND ISLAND NE 68803
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<br />NOTICE' OF STATE TAX LIEN
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<br />citlNilllllOl1t
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<br />PLEASE DO NOT WRITE IN THIS SPACE
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<br />This Notice of State Tax Lien is Iss,ued ~Y"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 acauired.,
<br />Nebraska Identification Number Faderalldentification Numb,r
<br />
<br />7402171
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<br />47-0791041
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<br />Lien Filed With Social Security N\Jmber
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<br />" [!I,Reglster bf Deeds', 0 County Clerk , -
<br />: . , I' . I ..
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<br />Date o(Li~n !, .:-h.: ,):'. -:,:':; ," :'.:_~" "".l:-!lJ~,:r~pe:,.;' ,- , ' :; ,::.. ,'" _" . - County "'" _ _ ';..
<br />'11/13/2006 ' [!]:Original DConti~~~tio~' , "Dc~;~~ied:-' "'" ~~~if-,',,;'" ,.,. _ ," ... m, -," '-",
<br />BUSINESS NAME AND LOCATION ADDRESS . - TAXPAVER'~AME'AND'MAIt.ING ADDRESS..,.
<br />
<br />Lien Serial Number
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<br />'fF.,\ DlO {004t7' :',
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<br />Spouse's Social Security Number
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<br />I
<br />
<br />,- ,,1
<br />
<br />B_usines~ Nam,e_ , ,
<br />
<br />Name
<br />A & N, Inc.
<br />Street or Other Mailing Addres~
<br />228 Cherokee Ave
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<br />Street Address
<br />
<br />Grand Island
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<br />State
<br />NE
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<br />Zip Code
<br />68803
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<br />City
<br />
<br />State
<br />
<br />Zip Co~e
<br />
<br />City
<br />
<br />I Tax
<br />Category
<br />Number
<br />
<br />21
<br />
<br />Tax Period Dats of Amount of Tax Penalty Interest
<br /> Assessment
<br />01/01/2004- 06/0812005 - "'1,81 t.34 422.32 250.95
<br />12/31/2004
<br />01/0112005- 11/0212006 850.00 212.50 78.53
<br />03/31/2005
<br />
<br />Additions
<br />
<br />Balance of
<br />Assessment Due
<br />
<br />2,484.61
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<br />21
<br />
<br />1,141.03
<br />
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<br />T9TAL'
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<br />'u $
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<br />.....3;265:'64 -- U -
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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 ani oiint 'shoWn' to be' due, and the taxpayer has- fall~d to 'pay the amount due after demand. If this Notice ,of, State
<br />Tax Lien is an extension f an effective lien, 'It serves to continue the priority of the state's interest in the affected property of the taxpayer.
<br />
<br />, 306 385-6073
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<br />
<br />- Revenue Senior AQE!ht
<br />Title
<br />Revenue Supervisor
<br />Title
<br />
<br />11/13/2006.
<br />Date
<br />
<br />Telephone Number
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<br />-4-'194-'974 Rllv. 2-2002 Sl4lorsecl.. 4-'194.1974 Rev_ 'c-'~m'
<br />
<br />sign
<br />here
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