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<br />12/11/2006 17:58 FAX 14024714429
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<br />NEBRASKA Dee
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<br />l~t002/002
<br />
<br />of{)
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<br />N. Se" D. SiDi. ........ II ID'. . U~~ ST~
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<br />200610965
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<br />998&484586-5 P!IiI5 : 1
<br />IdIL.SEY GRYL.E L.,
<br />Filed: 12/11/2006 03:34 PM
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<br />Pleas~ Return Original Copy to the
<br />Nebraska Dept. of Revenue at 200
<br />South Silber, North Platte, NE
<br />69101
<br />
<br />Ir
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<br />
<br />NOTICE 'OF STATE TAX LIEN
<br />
<br />I'IC1i1(la~
<br />.pa~6~
<br />ot~
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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. 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 Identificalion Number Fedenilldenlification Number
<br /> , , 35505419
<br /> . '.'
<br />Lien Serial Number: . .. " --,' . Lien Filed With ' , Social Secu'ritY Number Spouse's"Sc.i"ciilr Security:l\Jumber
<br /> . , ..~ . ..
<br /> , . 524.!:lQ4,1\t., " 1.1'"" \'/,~'.,;." 1!l,5e,gi!l,\El,r~.p~,dS, __ 0 C~unty 91e~ 506-80~6603 ' 505~02-6ib4:'o"
<br /> ,-- ., . :.1/' r _',.'~"_ "~_ _~.', t,'. , .. ,. , .
<br />Dale oftjEin1 --..,-',,"- ',' ,:', j,', ,: ".;.:~ :'.: ,:;",1 ,-'.Llen,Type::f"/., ,/ -,', :''', , :' ;,,: ',' , ' (;.ounly,~-,:, .i . ...... ,'"
<br /> - . :'!':'>11/0zl2'dd1:f "Y_':~~.:<":,,,:, r~TO~ghl~ltJC~ntiniiilti~iY" :',: 'D'Corre~led . '..'.",: .~. " _ . c. _,.:i:' "-1, .~~!-t_
<br />, -- , , ,;t;iALk ". ,..: 1,_::';, ,_' :.)'::':'l
<br /> , ... ~.. - --. H'
<br />I . . BUSINESS NAME 4ND LOCATION Al?D~SS TAXPAYER NAME AND'MAILING ADDRESS I
<br />Business Name Name
<br /> GAYLE L. WILSEY
<br />Street Address Street or Other Mailing Address
<br /> 722 SOUTH SYCAMORE ST
<br />City State Zip Code Cl1y State , Zip Code.
<br /> GRAND ISLAND NE 68801
<br />Ica~a:o-rY - "
<br />'I..I"'"_~,-,".... ""-'.~'~ ~."1~ ~ _ _ ..... '~"'IIt'":t.-_~.- _.=....M_ - . --.!..:...:.........Iw........ " -::;-.....-. -'. .r"--........-=--..-..:~..........~_~ ='~.........~~~......-T
<br /> . ~~....---.-..-.--...=-~ I-'u~~'- .
<br /> Tax Pertod Date of Amount of Tax Penalty Interest Additions Balance of
<br />Number Assessment Assessment Due
<br />22 2004 06/14/2005 136.68, 46.30 18.17 201.15
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<br />- .- ~ 'n,. . H -- TOTAL $-- 201.15
<br /> ."....
<br /> .' . ,'. .~.
<br />
<br />sig'ri ...
<br />here ...
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<br />I hereby certifY that the Nebraska Departmenl of Revenue has complied with the revenue laws of the State of Nebraska in the
<br />_., .' determination of the amount shown 10 be due, and the taxpayer has failed to pay the amounl due after demand,.If this Notice of State
<br />- .. 1axUen- r: "6 e~ersioi"of an' eff~ctive lien,..It serves '10 'conlinue the' priority of the state's intereslln the affected property of Ihe taxpayer.
<br />
<br />y, ':. ' ' ."'. ReveMLie Agent '. ~ ' 30B 535-8294
<br />Title Date' . "Telephone Number.:' _..'
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<br />Revenue Supervisor /eJ- 7-06
<br />Title Dale ' &
<br /><1-494.1974 Rev. 2-2002 S~p.r$lld.. ~9<l'197<1 Rev, 10---19
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