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<br />11/15/2006 17:00 FAX 14024714429 <br /> <br />NEBRASKA uee <br /> <br />raJ 0021002 <br /> <br />Df{) <br /> <br />200610243 <br /> <br /> <br />STI. <br /> <br />Please return to; <br />STATEOFNEBRASKA . <br />DEPARTMENT OF REVENUE <br />18'11 WEST 2ND ST STE 460 <br />GRAND ISLAND NE 68803 <br /> <br />-,-~-----""""" <br /> <br />IIr <br /> <br /> <br />NOTICE' OF STATE TAX LIEN <br /> <br />f1cbrtJb <br />citlNilllllOl1t <br />vf N\'OIM <br /> <br />PLEASE DO NOT WRITE IN THIS SPACE <br /> <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 <br /> <br />47-0791041 <br /> <br />Lien Filed With Social Security N\Jmber <br /> <br />" [!I,Reglster bf Deeds', 0 County Clerk , - <br />: . , I' . I .. <br /> <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 <br /> <br />'fF.,\ DlO {004t7' :', <br /> <br />Spouse's Social Security Number <br /> <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 <br /> <br />Street Address <br /> <br />Grand Island <br /> <br />State <br />NE <br /> <br />Zip Code <br />68803 <br /> <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 <br /> <br />21 <br /> <br />1,141.03 <br /> <br />" <br /> <br />~ - ~ <br /> <br />, : <br /> <br />, - <br /> <br />" .' <br />, , <br /> <br />, . ! ~ ~ <br /> <br />T9TAL' <br /> <br />'u $ <br /> <br />.....3;265:'64 -- U - <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 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 <br /> <br /> <br />- Revenue Senior AQE!ht <br />Title <br />Revenue Supervisor <br />Title <br /> <br />11/13/2006. <br />Date <br /> <br />Telephone Number <br /> <br />:..~ ~;hf-. <br /> <br />-4-'194-'974 Rllv. 2-2002 Sl4lorsecl.. 4-'194.1974 Rev_ 'c-'~m' <br /> <br />sign <br />here <br />