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<br />10/09/2007 TUE 15:30 FAX 402 471 4429 UCC SECRETARY OF STATE ~~~ Hall <br /> <br />121002/004 <br /> <br />D'b <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 /> <br />9907:528746-8 PSIS' 1 <br />JANOVEC DAVID J <br />Filed: 10/09/2007 10,23 AM <br /> <br />200708676 <br /> <br />'r <br /> <br /> <br />NOTICE OF STATE TAX LIEN <br /> <br />1'l0lltUka <br />clop.e*,~ <br />~ rt'ttfK!O <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 iawsof the state of <br />. . .' - <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'unpald 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 <br /> <br />Federal Identification Number <br /> <br />.8~Q9123 '. <br /> <br />l:ien Serial, N~mber ,,/ . Lien Filed With <br />, "';';',','" - -'I......;" I~ r..,4-it <br />" J~ II) , I LlLI," " I!];Register of Deeds 0 County 'Clerk <br />Date of Lien " Lien Typ~. . . <br />1 0/05/2007 [~]origlnal 0 Continuation <br /> <br />BUStNESS NAME AND LOCATION ADDRESS <br />Business Name <br /> <br />91-1762829, <br /> <br />'. ~' <br /> <br />Social:Security MUITI.ber: <br />, 505,;;62;.,9418 <br /> <br />Spouse,'s.Social Security Number <br /> <br />I <br /> <br />County <br />" " tJcorre~ted' "Hall' <br />TAXPAYER NAME AND MAtLING ADDRESS <br /> <br />I <br /> <br />Street Address <br /> <br />Name <br />. DavidJ Janovec <br />Street or Other Mailing Address <br />7200 South 20th <br /> <br />City <br /> <br />State <br /> <br />Zip Code <br /> <br />City <br /> <br />Lincoln <br /> <br />r Tax <br />Category <br />Number <br /> <br />Tax Period <br /> <br />Date of <br />Assessment <br /> <br />Amount of Tax <br /> <br />Penl!lty <br /> <br />Interest <br /> <br />01 <br /> <br />1 ~/01/2002~ ....19.(03/2006 <br />,::fl.1.'13012eO,6_, _'_..............._..... - ~ - .., <br /> <br />_._.~..~~~:~Q.. _. 1,580.77 547.51 3,163.08 <br />---....'''-...................-.. .. . _._..-.~"',...".... .--. . .------ - -_._..,.~.',...~"....,......._ __......_.___.._... __ ______.__.. -''-_n_ ___m..,. ...,._._._.____._.. . _.___ <br /> ._....._. .,;.;""""',.rT<..,.,,-.".r::r."'rn.m"ULI'-----'~~____ <br /> <br />- , <br /> <br />" <br /> <br />, <br /> <br />TOTAL <br /> <br />" <br /> <br />$ <br /> <br />3,163.08 <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 dLie after demand. If this Notice of State <br />Tax Lien is an extension of an effective lien, i1serves to conti!1ue the priority of the state's interest in the affected property oflhe taxpayer. <br /> <br />. .. ~...P;a't~j .Revenue Senior Agent JO I~I d,tJ07 308 385-6073 <br />sign Preparer's ignature .,., Title ' Date Telephone Number <br /> <br />here .... Revenue Supervisor /~ ~7 <br />Title Da <br />4-4901-1974 Rev. 2.2002 Super5edes 4-4901.1974 Rev. 10-1995 <br /> <br /> <br />~... <br />