|
<br />04/11/2007 09:36 FAX 14024714429
<br />
<br />NEBRASKA Dee
<br />
<br />141 002
<br />
<br />0'&
<br />
<br />IIIJI"I~~IIII'
<br />
<br />
<br />
<br />GOODRICH ~RRK 0 ~9s; 1
<br />Filed; 04/10/2007 11:16 AM
<br />
<br />Please return to:
<br />5T A TE OF NEBRASKA
<br />DEPARTMENT OF REVENUE
<br />1811 WEST 2ND 8T 8TE 460
<br />OR.AND ISLAND NE 68803
<br />
<br />IIr
<br />
<br />
<br />200702922
<br />
<br />NOTICE OF STATE TAX LIEN
<br />
<br />~Mka
<br />dllWil1llltnl
<br />~ rtYtn'"
<br />
<br /> PLEASE DO, NOT WRITE IN THtS SPACE
<br /> This Notice of State Tax L1~n is issued by the Nebraska Department of
<br /> Revenue for unpaid taxes pursuant to the revenue laws'ofthe"state--of
<br /> Nebraska. Notice is hereby given thaUaxes 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 iien
<br /> In the county for real and personal property .belonglng to the taxpayer
<br /> or hereafter acquired.
<br /> Nebraska Iclentificstion Number Federal Identification Number
<br /> i 9078541 ,.
<br /> ,
<br /> Lien Serial Number. . . . Lien Filed With . Social Security Number Spouse's Social.~e~urity Number
<br /> h1-l"6J'( OD ,q'''' ," .,:.~", 0"R'~~~;~~.'~f:D~ed~ :i..[j b~u~~y~ ~'Ie.r1<.~" :.J.: .;,':-.~b~. -o8:.7~8P:, ',-'; , '.l~:' - . .,' , T ~-, 'r' "
<br /> ,I _ _, '..,. . - ~'. h:"- . ..
<br /> : 1 -, -, ... - ~ ~ - - - -, ,'-:"" ;," ...._~ .
<br /> Date' of Lien " - " ~. . -Lier:CT.ype-' : ;....: '":'.~..~. ' .. ,.'. .:':: ........ ~..: ".::.':'.") .~o.u.n!'y:; '. ~~' :" .', - I
<br /> ,._",_ r~_....~...~ -,' .
<br /> I!h~r~ln~I.D~?nt!nU~IiO~... ,Dcorrected: . ... ... .- ._ r_......~ , -..---..
<br />.~_. ... ,....; 04/06/2007.... ~ Hall..":~' r '.
<br /> .. ----~ -',' "
<br />I : BUSINESS NAME AND LOCATION ADDRESS : TAXPAYER NAME AND MAILING' ADD'RESS "nn ,. --I
<br /> Busine s Name Name ,
<br /> , Mar!( D Goodrich
<br /> ,
<br /> Street I ddriess Street or Other Mailing Address
<br /> 2831 Wortman Ave, # 7'
<br /> City State Zip Code City State Zip Code
<br /> Grand Island NE 68803
<br />I Ta i I
<br />CateS! oryj Tax Period Date of Amount of Tilx Penalty Interest Additions Balance of
<br />Num eri Assessment Assessment Due
<br /> 01 01/01/2004- 03/04/2005 1,233.97 252.07 248.43 1,734.47
<br /> I 12/31/2004
<br /> ,
<br /> - - -
<br /> I
<br /> n_ '_"J.'n' . . -. . . . . . .
<br /> - . .. . , .. . .
<br /> ., .. ..-- ."..-
<br />, ,.--,',-, ~~~, .... ....J .--
<br /> ... . .. - ,. . n'_" _~ . . .. .. . .-
<br /> .. ... .. ." , .. -- .. , 1 ,734A7 . '-' ...
<br /> .' - -- rOTAL $
<br /> ... -- " ... --
<br /> ., '.-
<br />
<br />"'hereby'certify thaI the .Nebraska .Department of Revenue has complied wit~Jh~ .revenue laws .of Ihe State of Nebraska in the
<br />detemination of the amount shown to be due, and the taxpayer has failed 10 pay Ihe - amounf due"afleFi:lemahd::lfthis . Notice of State '
<br />Tal< Uee ;, '" "":1"J'-" I~e, , ...... to ",e'''''' Ie; "'''' of ... ".le', ,ei,,,,,, In th, .ff..... propo"" ofth, .."'.,."
<br />
<br />.. .. C') J~ . Revenue Senior Agent 4/ (p I :J. ()t)7 .. 308 385-6073
<br />.slgn Preparer's Signature Title ,Date Telep~ N~mber
<br />here Revenue Supervisor ~ /6"1
<br />T. D~
<br />~-494.'97~ Rev, 2-2002 Supersedes ~-494-1974 Rav. 10-'995
<br />
<br />
<br />. n
<br />
|