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<br />06/12/2007 TUE 15:22 FAX 402 471 4429 UCC SECRETARY OF STATE ~~~ Hall <br /> <br />1dI003/005 <br /> <br />20070tl890 <br /> <br />11111'1111111 ~lll' <br /> <br /> <br />9907513182-5 Pgs. 1 <br />LEISER WILLIRl'I G . <br />Filed: 06/12/2007 12:45 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 />\)\ <br /> <br />Ir <br /> <br /> <br />NOTICE OF STATE TAX LIEN <br /> <br />lI.tub <br />"""mtllt <br />W.rmnuo' <br /> <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 constitute a lien <br />In the countY for real and personal property belonging to the taxpayer <br />'or hereafter acquired. <br />Nebraska Identification Number Federal Identification Number <br /> '24069427 <br />Lien Serial Number Lien Filed With Social Security Number Spouse's Social Security Number <br /> 52940043, I&l Register of Deeds o County Clerk 505-88-8639 505-94-6613 <br />Date of Lien Lien Type' Coun!y <br /> 06/06/2007 I&l O~iginal 0 Continuation D Corrected HALL' <br />I BUSINESS NAME AND LOCATION ADDRESS TAXPAYER NAME AND MAILING ADDRESS I <br />Business Name Name <br /> WILLIAM G. & SANDRA K.'LEISER <br />Street Address Street or Other Maifing Address <br /> 4425 N ENGLEMAN RD <br />City State Zip Code City State Zip Code <br /> GRAND I$LAND NE 68603 <br />I Tax I <br />Category Tax Period Date of Amount of Tax Penalty Interest Additions Balance of <br />Number Assessment Assessment Due <br />22 - "'2.00 \ i 08/30/2005 282.09 14.10 95.65 391.84 <br />22 <'2..004 ; 01/15/2007 83.00 4.15 11.42 98.57 <br />I <br /> TOTAL $ 490.41 <br /> <br />sign ... <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 to pay the amount dueafier demand. If this Notice of State <br />Tax Lien an extension of an effeer e lien, it selVes to continue the priority of the state's interest in the affected property of the taxpayer: <br /> <br />Revenue Agent t e -d I 308 53~-8294 , <br /> <br />Title Date Telephone Number <br /> <br />Revenue Supervisor ttr&'"Ol <br />Title Date <br />4-<194-1974 Rev. 2-2002 Supersede$4-<19<4-1974 Rev. 10-1995 <br /> <br />V <br /> <br />