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<br />12/15/2006 16:55 FAX 14024714429
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<br />NEBRASKA Dee
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<br />~ 003/005
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<br />Ple8.'le return to:
<br />STATE OF NEBRASKA
<br />DEPARTMENT OF REVENUE
<br />1811 WEST 2ND ST STE 460
<br />GRAND ISLAND,NE 68803
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<br />200611135
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<br />NOTICE OF STATE TAX LIEN'
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<br />llO>bru~
<br />d'lIlll'Illllllll
<br />01 "'YOI\II'
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<br /> PLEA~E 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 heteby 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 .acQulred. ; : , . f .; "
<br />Nebraska Idenlification Number ' . Federalldenllflcallon Number',: .,....h, "
<br /> 1 ~"'" . I.,' .
<br /> '. ~. ... '. ~ ':." .'" " . . E" \ ; ~ :: . I' , '/' - "10'.' ~,. :. , I ' ~ ,~:"~'; '.:':.:.: ~.',~.:~ :4:(0845288' i ~c': ;.~. .',~ . , , ~ 7' :
<br /> ,. -- 8738122",' , -- , -- ........ - ,_ "__r._ " - r~ :
<br /> , : - . . . I ._, ,-, .... -.. . .... . :-'" - 01.' b_'. . ...... ,~ -- ""............ r
<br />Lien Serial Number Lkin Filed With.. ,,_ .. _ . . L _ .. .. .., , ~ ~ , ,S~c<ia.! :S,c!lrity.N,~r:n~,er,: ' :. ,~p~use;,s~~~ial S~,:~rltY N.um~r
<br /> O?;IC1D{ D05~ [~IRegister of Deeds D County Clerk .
<br /> : 506-84-:3916 :
<br />Date of lien lien Type, County , .- . , .... .
<br /> 12/13/2006 ~ Original D Continuation' D,Corrected ' Hall
<br />I BUSINESS .NAME AND LOCATION ADDRESS TAXPAYER NAME AND MAILING ADDRESS, I
<br />Business Name , Name
<br /> Tracy A Markham
<br />Street Address Street or Other Mailing Address
<br /> 16 Venus
<br />City State Zip Code ' City State Zip Code
<br /> Aida NE 66610
<br />I Tax I
<br />Category Tax Period Date of Amount of Tax Penalty Interest Additions Balance of
<br />Number Assessment Assessment Due
<br /> 01 12/01/2005- 11/03/2006 5,317.96 453.60 190.05 5.961.63
<br /> 06/31/2006
<br /> 21 01/01/2006- 11/09/2006 236.33 '62.80 13.70 312.63
<br /> 06/30/2006 -'
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<br /> ..
<br /> '" "'r', . .... ..
<br /> .. I'::" . .. . ~ " '.-" -- .. :'" ~
<br /> . , -' ,
<br />,- -- .- . ~,.". M'~' ..,. .... . " .:M' ;.. TOTAL" 'I.' , $:' ':"..6,274.46
<br /> . - -- -, '. -,....' .",.. "... .. .~ ,~ . .,.. " . ,".'
<br /> ,''', -" ..
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<br />sign
<br />here
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<br />I hereby ce~ify that the Nebraska Department of Revenue has complied with the revenue laws of the State of Nebraska In the
<br />.. detennination of the amount shown, to be d,ue, and the taxpayer has failed to pay. the amount due after demand. If this Notice of State ,
<br />Tax Lien is an extension of ' an effective lien, it serves to continue tpe priority of the'state's interest in the'affected property of the taxpayer:
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<br />\.P Revenue Senior Agent tdJ/).L) / ~D()h 30B 385-6073
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<br />... Preparer's Signature Tille Date' Telephone Number
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<br />Revenue Supervisor I~h 0~
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<br />Tille Oat f95\\-:\
<br /><1..019<1-197-4 Rev. 2-2002 Supersedes <1-'194--197<1 Rev. 1o-\.~~~
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