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<br />06/12/2007 TUE 15:23 FAX 402 471 4429 UCC SECRETARY OF STATE ~~~ Hall <br /> <br />1dI004/005 <br /> <br />()~ <br /> <br /> <br />9907513183-7 <br />COTE LEROY G. <br />Filed: 06/12/2007 12;5B PM <br /> <br />200704891 <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 />'r <br /> <br /> <br />NOTICE OF STATE TAX LIEN <br /> <br />IIllbruklt <br />follll'lil\oill <br />04' tW4I\\It <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 /> 12459178 <br />Lien Serial Number Lien Filed With Social Security Number Spouse's Social Security Number <br /> 61600225 ~ Register of Deeds o County Clerk 506-34-3402 507-38-0142 <br />Date of Lien Lien Type County <br /> 06/08/2007 ~ Original 0 Continuation o Corrected HALL <br />I BUSINESS NAME AND LOCATION ADDRESS TAXPAYER NAME AND MAILING ADDRESS I <br />BusinElSs Name ./lJame <br /> LEROY G. & JOSEPHINE K. COTE <br />Street Address Street or Other Mailing Address <br /> 2206 N CUSTER APT C <br />'City State Zip Code. City State Zip Code <br /> GRAND ISLAND NE 68803 <br />I Tax ,- <br />_ Category Tax Period Date of . Amount of Tax Penally Interest Additions Balance- of <br />Number Assessment Assessment Due <br />22 2003 04/24/2006 1,461.00 84.35 330.36 1,875.71 <br /> TOTAL $ 1,875.71 <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 due after demand. If this Notice of State <br />Tax Lien' an extension of an effective lien,' it serves to continue the priority of the state's interest in the affected property of the taxpayer. <br /> <br />. f - Revenue Agent b :/ -0 7 . 308 535-8294 <br />are!' Si natur Title Date Telephone Number <br /> <br />Revenue Supervisor 6-F-o) <br />T~ ~~ <br />4~94-1974 Rev. 2-2002 Supersedes 4~94-1974 Rev. 10.1995 <br /> <br /> <br />\}" <br />