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<br />03/02/2007 13:25 FAX 14024714429
<br />
<br />NEBRASKA Dee
<br />
<br />141 0021004
<br />
<br />oq,
<br />
<br />Please return to:
<br />STATE OF NEBRASKA
<br />DEPARTMENT OF REVENUE
<br />1811 WEST 2ND ST STE 460
<br />GRAND rSLAND NE 68803
<br />
<br />200701602
<br />
<br />
<br />9907498362-7 Psn, 1
<br />LOCKMAN BRIAN
<br />Filed: 03/02/2007 11:17 AM
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<br />NOTIC.E>OF STATE TAX LIEN
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<br />: ,TAXp~'(r;:R.t)lAME'AN[l..MAiJ;;INC{.ADDRESS
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<br />Name, ',,',"',
<br />Biisui'Lockman
<br />Street or Other Mailing Addre$s
<br />65524 235th Stree~ . ,
<br />
<br />Zip Code City i 1 State
<br /> Glen , ood I IA
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<br /> i ,
<br />Amount of Tax Penalty I Inter~st , Additions.
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<br />1,960.63 196.08 261.ia ,
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<br />25.00 -lb~ '2.1
<br /> I
<br />
<br />Zip Code
<br />'5153:4
<br />
<br />
<br />2,41 B.:19
<br />27.16
<br />
<br />sign
<br />here ...
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<br />TOTAL
<br />
<br />$
<br />
<br />2;445.37
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<br />',1
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