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<br />12/15/2006 16:55 FAX 14024714429 <br /> <br />NEBRASKA uee <br /> <br />IaI 002/005 <br /> <br />200611134, <br /> <br /> <br />STL <br /> <br />at() <br /> <br />Please Return Original Copy to the <br />Nebraska Dept of Revenue at 200 <br />South Silber, North Platte NE ' <br />, <br />69101 <br /> <br />ar <br /> <br /> <br />NOTICE OF STATE TAX LIEN <br /> <br />IllllW.~ <br />...,.itMtrif <br />Of ...... <br /> <br />PLEASE DO NOT WRITE IN THIS SPACE <br /> <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 acauired. <br />Nebra$ka Identification Number, Federal Identification Number <br />, 33101604 <br /> <br />Lien Seria,! Number Lien Filed With Social Security,Number Spouse'~ Social Security, N,umber <br />6266,0091 '" " '~Re9ister ofDeeds ,0 coun~ Clerk 506-52~0976' " 505-90-~~11, e' ".. <br />Date of lien :',',"",,,,;: "''''-''LienType'','":,,. .... '., County~';... .. ", <br />.. " '12i13/20ci6.':~'; ',' ,'" ~ 6~_gin~1 D,6ti~.i'i~uatl~,n" '.-:: .-: 0 Corrected' " " "HALL', .. ' . ''-;, "hi" <br />I BUSINESS NAME AND LOCATION ADDRESS TAXPAYER NAME AND MAILING ADDRESS e I <br /> <br />Business Name <br /> <br />Name .." <br />JOHN J. RICE & SHERI L. RICHMOND <br />Street or other Mailing Address <br />3424 SCHROEDER AVE <br /> <br />Street Address <br /> <br />. City <br /> <br />22 <br /> <br />2004 <br /> <br />State Zip Code City State Zip Code <br /> GRAND ISLAND NE 66803 <br />Date of Amount of Tax Penalty Interest Additions Balance of I <br />Assessment Assessment Due <br />07/31/2006 594.00 29.70 59.27 662.97 <br />04/24/2006 179.00 13.95 43.56 236.51 <br /> <br />I Tax <br />Category <br />Number <br /> <br />Tax Period <br /> <br />22 <br /> <br />2003 . <br /> <br />::,.- <br /> <br />, -,TOTAL <br /> <br />. - $,' "'" '919.48, <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 />detelTTlination of the amount shown to be due, and the taxpayer has failed to pay the amount due after der:nand. If this Notice of State <br /> <br />sign - .. <br />here ... <br /> <br /> <br />_ n e~ensjon of an_ ~ff~ve lien, ~t servasto continue the priority of the state's interest in the affected property of the taxpayer. <br />, Revenue Agent /::i..-f 3 --Ot:> 30B 5'35:'8294 <br />Title Date Telephone Number- <br />Ja..r-13 -tJ6" . <br />Da~ ~ <br />4-494-1974 Rev_ 2-200'- Supersedes 4-494-1974 Rev. 10-1!ile5a~'\+J <br />\ ' <br />\ <br /> <br />Revenue Senior Agent <br />Title <br />