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<br />03/13/2007 14:53 FAX 14024714429 <br /> <br />NEBRASKA Dee <br /> <br />IaI 005/005 <br /> <br />;, <br /> <br />cr <br /> <br />i <br />:1 <br /> <br />" <br />, <br /> <br /> <br />9907500186-8 Pes: 1 <br />ItEYERS JOHN C. <br />Fiied: 0311312007 11:53 AM <br /> <br />200701912 " <br /> <br />1 <br />,I <br /> <br />Please Return Original Copy to,the <br />Nebraska'Dept. of Revenue at 200 <br />South Silber, North Platte? NE <br />69101 <br /> <br />ar <br /> <br /> <br />:1 <br />I <br />'I <br />I, <br />i <br />NOTICE OF STATE TAX LIEN <br />- , I . <br />" <br /> <br />_tr4~ <br />'*~ <br />ot....-. <br /> <br />I <br /> <br />This Notice of State Tax Li n!is i,sued by t e Nebraska Department of <br />Revenue'for unpaid taxes ursuant to the r venue laws' of the,state of , <br />Nebraska. Notice Is hereby ~ven ,that,taxe Including penalties and <br />Interest, which are shown e~ow, are due f m the taxpayer specified : I <br />below and remain unpaid a 8r demand. Th se taxes constitute a lien ; I <br />in the county for rea~ and r~ona,1 prope belonging to the taxpayer <br />or hereafter ae uired. ' i <br />Nebraska Identificatlqn Number <br /> <br />I! PLEASE DO NOT WRITE IN THIS SPACE <br /> <br />Dateiof Lien'" <br />I., ' <br />I. <br /> <br />, , <br />I. ' <br /> <br />i <br />I . Lien Filed ith ' <br />'l -, [gJ-Register <br />:11, Llen_ Type: <br />[~Jbrlginal <br />cpCATION ADORE 5 <br /> <br /> <br />II <br />Federal Identification Number <br /> <br />23916605 <br /> <br />:1 <br />t: <br /> <br />Lien Serial Number <br />63260033: <br /> <br />-0 County Clerk <br /> <br />Social S~CUrity Numtier , <br />5b~-88-_3172 -, ' <br />, ! ' , <br />", I County ,.--' , <br />Dcorrected 'I '- .-, 'HAll~'-:-"'-_ <br />TAXP~YER NAME AND MAILING ADDRESS' <br />Name j <br />JOHN C. & ~USAN M. MEYERS <br />Street or other MBilln!!~Address <br />, 11070 S BUFFALO RD <br />City ;: <br />DONIPHAN!!' <br />,I <br />! i Inter8lit <br />!: <br />'I <br />:,1,489.58 <br />,I <br /> <br />Spouse's Social Security Number <br />.. 907-90-1248 <br /> <br />03/09/~007 <br /> <br />BUSINESS NAME AND <br />Business Name <br /> <br />Street Address <br />City State Zip Code <br />Tax <br />Category Tax Pe.riod <br />Number <br />22 200: <br /> <br /> <br />State <br />NE <br /> <br />Zip Code <br />68832 <br /> <br /> <br />Penalty <br /> <br />Additions <br /> <br />Balance of <br />Assessment Due <br /> <br />1,562.79 <br /> <br />9,303.52 <br /> <br />" <br />" <br />:1 <br />[1 <br />:! <br /> <br />'; <br /> <br />:1 <br /> <br />sign <br />here to <br /> <br />: TOTAL $- 9,303.52 <br />I. <br />I hereby certify that the Nebra ka Department of Revenue has complied with the revenue laws of the State of Nebraska in the <br />determination of the amount s oWn to be due, and the taxpayer has failed to pay the amownt due after demand. If this Notice of State <br />Tax Lien - an eXtension of n ff~clive lien, it serves to continue the priority of the state's 'Inlerest in the affected property ofthe taxpayer. <br /> <br />1 Revenue Agent _: ~ q ~ '/ 308 535-8294 <br /> <br />IlIe ' Date - Telephone Number <br /> <br />Revenue Supervisor .?-7'- ") <br />I, _Tille " Date <br />4.....94.1974 Rov, 2-2002 Supsr."d.s 4-'194-1974 Rov, '0-'99h~\ <br />;, ' \ fU <br /> <br />