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<br />04/09/2007 15:29 FAX 14024714429 <br /> <br />NEBRASKA Dee <br /> <br />~ 002/002 <br /> <br />200702869 <br /> <br />111111"11111 <br /> <br /> <br />S~IDT ROCKY L PS5' 1 <br />FlJed; 04/0S/2~7_!2:21 PM <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 />o~ <br /> <br />. <br />...: <br />~~' <br />of~ <br /> <br /> <br />_NOTICE OF STATE TAX LIEN <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 shbwn 'below, are due from the taxpayer specified <br />below and remain unpaid after demand. These taxes constitute a lien <br />in the county foneal and personal property belonging to the taxpayer <br />or hereaiter aCQuired. <br />Nebraska:ldentiflcalion Number Fecleralldentlfication Number <br />36004766 <br /> <br />Uen seri,' Number ._ . Lien Filed With <br />63260060 [g] Register of_ Deeds D County Clerk <br />, . 'Lien Type' - , ,- <br />'04/0Si2007- ' ~ Original' D Contin~ation , <br />BUSINESS NAME AND J.OCATION ADDRESS <br /> <br />Social Security ,Number <br />506-94-5645 <br /> <br />Spouse's Social Security, ,Number <br /> <br />Dale of Lien . <br /> <br />, County <br />D Corrected' .. H,t,LL :' - , <br />TAXPAYER NAME AND MAILING ADDRESS <br /> <br />1- <br /> <br />I <br />Business Name <br /> <br />Street Addre_ss <br />City <br />I Tax <br />Category Tax Period <br />Number <br />22 1999 <br />22 2000 <br />, 22 2001 <br />22 2002 <br /> <br /> Name <br /> ROCKY L SMIDT : <br /> Street or Other Mailing Atldress <br /> J' 3035 N WEBB RD <br />State Zip Code City State Zip Code <br /> GRAND ISLAND NE 68803 <br />Date of Amourit of Tax Penalty Interest " Additions Balance of I <br />Assessment ASsessment Due <br />09/1212006 4,172.66 1,04:3.17 2,107.59 7,,323.42 <br />01/23/2007 7,717.38 1,929.35 3,203.4~ . 12,850.18 <br />06/20/2006 1,025.00 256.25 333.24 1,614.49 <br /> : <br />06/20/2006 ' 364.00 91.00 88,70 : . 543.70 <br /> <br />T;OTAL <br /> <br />$ <br /> <br />22,3'31.79 <br /> <br />sig1:1 ... <br />here ".. <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 />determination of the 'amount shown to be due, and the taxpayer has failed 10 pay the amount due after demand. If this Notice of State <br />-'-Tax'Lien ,is,a' eXtel'!sion of an ffective lien, it serves to continue the priority of the state's interest in the affected property of the taxpayer. <br />I ..-, - - ' " <br /> <br />.. Revenue Agent 45:.-0 7 308 535-8294 <br />Title Date Telephone Number <br />Revenue Supervisor 'SI-)-1::) ? <br />Title Date <br />4--494-1974 Rev, 2-2002 SupersodBll 4-'194-1974 Rov, 10-1995 <br /> <br /> <br />\L---- <br />