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12/01/2006 17:51 FAX 14024714429 NEBRASKA Dee tal 0021002 a90, 200610708 111111"'11 9906483013-9 PSI', 1 FOKKEN DARREL IC Filed: 12/01/2006 03:40 PM Please Return Original Copy to the Nebraska Dept. of Revenue at 200 South Silber, North Platte, NE 69101 Ir 'Notice of State Tax Lien n.braskiI depilrtment of revenue PLEASE DO NOT WRITE IN THIS SPACE INDIVIDUAL INCOME TAX SOC. SEC. NO. NEBR. IDENT. NO. , SPOUSE SOC. SEC. NO. TAXABLE YEAR .- LIEN NO. COUNTY DATE;OF.NOTICE OAT;!!:,' OF ASSESSMENT 484468652 38860414 550589979 , 2003 061040021 HALr,. ,04/14/2006 '.' 01/24/2006 DARREL K & VIRGINIA M FOKKEN 403 E 19TH ST GRAND ISLAND NE 68801 THIS NOTICE OF STATE TAX LIEN IS ISSUED BY'THE NEBRASKA DEPARTMENT OF REVENUE FOR INDIVIDUAL INCOME TAX PURSUANT TO THE REVENUE LAWS Of THE STATE OF NEBRASKA. - NOTICE IS HEREBY GIVEN THAT INDIVIDUAL INCOME TAXES INCLUDING PENALTIES AND INTEREST, WHICH ARE SHOWN BELOW ARE DUE FROM THE TAXPAYER SPECIFIED ABOVE AND REMAIN UNPAID AFTER DEMAND. THESE TAXES CONSTITUTE A LIEN IN THE COUNTY' ,FOR PROPERTY BELONGING TO THE TAXPAYER OR HEREAFTER ACQUIRED. AMOUNT OF TAX . . . . . . - . . . . . . 15,480.14 PENALTY . . . - . . . . . . . . 3 ~ 870.04 INTEREST (COMPUTED TO 04/14/2006) . . 1,855.07 TOTAL AMOUNT DUE - . . . . . . . . . . . 21.205.25 I HEREBY CERTIFY THAT THE NEBRASKA DEPARTMENT OF REVENUE HAS COMPLIED WITH THE REVENUE LAWS OF THE STATE OF NEBRASKA IN THE 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 TAX LIEN IS AN EXTENSION OF AN EFFECTIVE.LIEN IT SERVES TO CONTINUE THE PRIORITY OF THE STATE'S INTEREST IN THE AFFECTED PROPERTY OF THE TAXPAYER. ~/cV~... .~~.~.... ~~~~........... ATURE TITLE ' lieU fl" l;Qf);l5-cU-94 DATE/TELEPHONE . . . (' (~~~.&: . . . . . DATE QP , I i'T15 /