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<br />01/11/2008 FRI 15:35 FAX 402 471 4429 DCC SECRETARY OF STATE ~~~ Hall <br /> <br />121005/009 <br /> <br />200800290 <br /> <br />ct) <br />() <br /> <br /> <br />!lTL . <br /> <br />9908542743-2 pgs: 1 <br />KEESHAN JAMES K <br />Filed: 01/11/200802:36 PM <br /> <br /> <br />~ <br />Neb.."". D....._M o. <br />REVENUE <br />WWW."__l'1Iua.1'>..O_ <br /> <br />NOTICE OF STATE TAX LIEN. <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 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 counw for real and personal property belonging to the taxpayer <br />or.hereafter acquired. <br />Nebraska Identification Number Federal Identification Number <br />8891281 <br /> <br />. lien Serial Number Lien Filed With <br /> <br />. fJ3/o'k/a(Jn .~_~Regi$terClfD~~ <br />Date of Cien , lien Type <br />"01/04/2008 '-'. I~1.0riginal 'Ocontinuation <br /> <br />". aUSINESS NAME:AND LOC4T!ON ADDRESS. <br />Business Name <br /> <br />Social Security Number <br />o County C~erk 505 84 1420 <br /> <br />Spouse's Social Security Number <br /> <br />. . "... .... <br /> <br />County <br />'OCorrecled . . 'Hall , _, <br />. . . TAxPAXER ~AMEAND,M~ILlNGADbRESS "', <br /> <br />.,). '. <br /> <br />'; '''1. <br /> <br />.. ..".. "~. <br /> <br />Street Address <br />City -stare Zip Code <br />Tax <br />Category Tax Perlcid . Date of Amount of Tax <br />Number AsseSSment <br />01 09/01/2006 12/04/2007 4\018.16 <br />07/31/2007. <br /> L <br /> <br />F!enalty <br /> <br />Interest <br /> <br /> . . <br />State Zip Code <br />NE 68801 <br /> . -~.. .. <br />Additions Balance of .. <br />,'.- - Assessment Due .. <br /> . .. <br /> 4,984.49 <br /> . .. <br /> . ~ -- <br /> .. ; <br /> .-....-....- <br /> . .. ; <br /> <br />City <br /> <br />.Grand Island <br /> <br />648.04 <br />. <br /> <br />318.29 <br /> <br />Please return to: <br />STATE OF NEBRASKA <br />DEPARTMENT OF REVENUE <br />.. 1811 WEST 2ND ST STE 460 <br />GRAND ISLAND NE 68803 <br /> <br />I <br /> <br />I <br /> <br />TOTAL <br /> <br />$ <br /> <br />. <br />4,984.49 <br /> <br />I hereby certify th~t the ~8b~ska Oepar:tm~nt of .Revenue.,has complied with the revenue law~ of the State of .Nebras~a In the" &;t~.~ln~tj~n.of the <br />. amour'lt shown to!>e due, and the -taxpayer has failed to pay the amount due after demand. If this Notice of State Tax Lien is an eidensionofan <br />effective lien, it serves to cOn' ue the priority: of the state's interest in the affected property of the taxpayer. <br /> <br />~,' . ..... . Revenue SeniorAgent- ....y4JM~. <br />sign Pr are 19na e - Title - Date ' <br /> <br />here Revenue Supervisor <br />Tille <br /> <br /> <br />. 30~ .}85~~Q73 _. <br />Telephone Number <br /> <br />0/10/00 <br /> <br />4-494-1974 Rev. 2-2002 SupersedN 4-494.1974 Rev. 1G-1995 <br /> <br />. '^ <br />-:r..V-L..' <br />