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<br />12/22/2006 17:24 FAX 14024714429
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<br />NEBRASKA Dee
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<br />Igj 004/004
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<br />Please return 10:
<br />STATE OF NEBRASKA
<br />DEP AR'IMENT OF REVENUE
<br />1811 WEST 2ND ST STE 460
<br />GRAND ISLAND NE 68803
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<br />200611362
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<br />IIIll'rl1l n II
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<br />9908486348-1 Plils: 1
<br />CULBERT LEE W
<br />Fil.d, 12/22/2006 10:55 RM
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<br />NOTICE OF STATE TAX LIEN
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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 co~stltute a lien
<br />in the county for real and personal property belonging to the taxpayer
<br />or hereafter acquired.
<br />Nebraska Identification Number Federalldenlificalion Number
<br /> 6854397, ., ,
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<br />Lien Serial Number . . . Uen Filed- With . . . . Social S~cu~ity N!Jmber. - , Spouse's Social Security Number
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<br />(())) Din r nnr::uA - - " - I. I ...... ,,':.J, ,
<br /> ~ Register of Deeds" 0 County 'C'leik' ..: 50072 9506-:: ; .:: . n. _.IT.... ., _.. n.
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<br />Date of Lien. \ I ' .~ , '. .." "Lie,n Typ~' , -, ..-. .. .... ......- . -__ -.._...._ "r. County- ..-.".-, .... . . ~. .
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<br /> : 12/21/2006 ~ 'original tJ c~ntlnUallori D Corrected: Hall i
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<br />r BUSINESS NAME AND LOCATION ADDRESS TAXPAYER NAME ANO MAILING ADDRESS' , .. I.
<br />Business Name Name
<br /> Lee W Culbert
<br />Street Address Street or Other Mailing Address
<br /> P, O. Box 5323
<br />City State Zip Code City Stale Zip Code,
<br /> Grand Island NE 68802
<br />I Tax -1
<br /> Category Tax Period Date 'of Amount of T;ax Pel:lalty Interest Addltlon$ Balance of '
<br /> Number Assessment Assessment Due
<br /> 01 10/01/2005- 06/07/2006 848.98 0.00 60.89 909,87
<br /> 12/31/2005'
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<br /> - -~. -, . -.- _ _ .. 'W. _. . w.. . ... . -...-. ~ .... ,,, ,.... TOTAt .
<br /> . .-- ," . " .., ..t.... $" 909.87-. --
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<br />. I hereby certify that the Nebraska Department of Revenue has complied with the revenue, laws of the State of Nebraska in the
<br />determlnallon of the amount shown to be due, and the taxpayer has failed to pay' the' amount due afte'r demand. If this Notice 'Of State"
<br />Tax Lien is an eldensron of an effective lien, It serves to continue the priority of the state's, interest in the affected property oritae'taxpayer.
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<br />. ... ci, !4 J:h J R~venue Senior AQent 1.2);4J.1 r:J no ~ 308 385--6073
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<br />sign Preparer's Signalure ) Title Date Telephone Number
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<br />here.. ./ Revenue Supervisor /;/ /3 ~'Dh
<br />Tille Date'
<br />4-484.197<1 Rev. 2-2002 Superslldes 4-49<l-1S7<l Rev. 1D-199Q,tf)
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