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<br />06/22/2007 FRI 15:23 FAX 402 471 4429 UCC SECRETARY OF STATE ~~~ Hall <br /> <br />fljo 0 3/ 0 0 3 <br /> <br />Jcf <br /> <br />200705297 <br /> <br />IJllllrllll1~1 <br /> <br />~YlILINS-HOSTEK KI"BERLY J . <br />1 ed: 06122'2007 11:43 AM <br /> <br />Please return to: <br />STATE OF NEBRASKA <br />DEPARTMENT OF REVENUE <br />1811 WEST 2ND ST STE 460 <br />GRAND ISLAND NE 68803 <br /> <br />IIr <br /> <br />NOTICE OF STATE TAX LIEN <br /> <br />nobfa$kll <br />dopol'lnllnl <br />Of 10\'0IW0 <br /> <br /> PLEASE DO NOT WRITE IN THIS SPACE <br />This Notice o,r 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 Federalldentifica\ion Number <br /> 8991022 <br />Lien Serial-Number Lien Filed With Social Security Number Spouse's Social Security Number <br /> n:a" n1 i_ ~- [!] Register or Deeds D County Cler1t ,506-96-7373 <br /> If )()~ , <br />Date of Lien Lien Type " , County <br /> 06/13/2007 m ,Original 0 Continuation D Corrected Hall <br /> BUStNESS NAME AND LOCATtON ADDRESS TAXPAYER-NAME AND MAILING ADDRESS I <br />Business Name Name <br /> Kimberly J Mullins-Mostek <br />Street Address Street or Other Mailing Address <br /> 3618 Palamino Drive <br />City State Zip Code City State Zip Code <br /> Grand Island NE 68803 <br />I Tax 'I <br />Category Tax Period Date of Amount of Tax Penatty Interest Additions Balance of <br />Number Assessment Assessmel1t Due <br /> 01 07/01/2005~ 05/14/2007 2,457.00 491.40 170.12 3,118.52 <br /> 12/31/2006 <br /> - <br /> . <br /> , . <br />"",,.,', ...-..,.....,. . .. <br /> ....--.. .........- ". ... . .n . ... n.... ...". .",. ' . ... '..",,, . ...,......--. <br /> - TOTAL - $ 3,118.52 <br /> <br />. .", ,...."........: <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. NOtlC8 of State . <br />Tax. Lien is an exlensio of a effective lien, it $erves to continue the priority of the state's intht in the affected property of \he taxpayer. <br /> <br />Revenue Senior Agent Y13 / A 7 308 385-6073 <br /> <br />Tille . Date. T8le"one N~7ber <br /> <br />Revenue Supervisor ~ / / 3 /IJ' <br />Title ~te I <br />4-494-1974 Rov. 202002 Suptlfsedes 4-494-1974 Rov_ 10.1995 <br /> <br /> <br />IL. <br />