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<br />01/25/2008 FRI 15:17 FAX 402 471 4429 DCC SECRETARY OF STATE ~~~ Hall
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<br />141003/003
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<br />Please return to:
<br />8T ATE OF NEBRASKA
<br />DEPARTMENT OF REVENUE
<br />1811 WEST 2ND ST STE 460
<br />GRAND ISLAND NE 68803
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<br />200800643
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<br />I Tlllllrr rn
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<br />9908545051-8 Pas: 1
<br />MARKHAM TRACY A
<br />Filed, 0112512008 02,34 PM
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<br />N.g......k.ii:l_l'IlI'\'IOet'I1. ~'
<br />REVEN'UE
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<br />WWW..'.V...,.....'....O..'"
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<br />NOTICE OF STATE TAX LIEN
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<br /> PLEASE DO NOT WRITE IN THIS SPACE
<br />This Notice of State Tax Lien I~ 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 penames 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 Federalldentificalion Number ,
<br /> ," 8738122 47;.0845288
<br />U~n Serial Number I __ Lien Filed With .Isocial Security Number Spouse's Social Security Number
<br /> [ERegister of Deeds DcountY Clerk _ XXX-XX-3916 . ...._~'. .
<br />, n~1 f)R\O(flnl" , " ,',
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<br />Date of -Lien . - ' Lien Ty,pe ",,' . ,.. ~oUl~ty ,-
<br /> " -, , ,-
<br />,-' , " Q-1/~3/2008 " - ,[EOriginal': ,OC~ritin'uati,o,n .:': o Corrected " Hall --'
<br />,/1. . " .- -- ,-
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<br />, - BUSINESS NAME AND lOCATION ADDRESS- .- ''- TAXPAYER NAME AND MAiLiNG AbDRESS'" .",- __ _..;._n ~
<br />Business Name Name ' ,
<br />..~,- . ..,-. - Tracy A Markham- ...-. . . ..~.._- ....-
<br />Street Address Street or Other Mailing Address
<br /> 16 Venus
<br />City State Zip Code City State Zip CQde
<br /> Aida NE, 68810
<br />Tax
<br />Category _ Tax Period Date ,of Amount of Tax Penalty Interest Additions Balance of
<br />Number Assessment Assessment Due
<br /> 09/01/2006- ' '
<br /> 01 01/31/2007 04/03/2007 1,163.41. 77.54 100.40 1,341.35
<br /> 01 03/01/2007- 1 0/17/2007 1,574.20 318.~4 74;99 1,968.13
<br /> 07/19/2007
<br /> 21 07/01/2006- 05/11/2007 96.75 24.19 9.20 130.14
<br /> 09/30/2006
<br /> 21 10/01/2006- 03/28/2007 121.94 12.19 7.57 141.70
<br /> 12/31/2006
<br /> 01/01/2007- -"...
<br /> 21 10/17/2007 332._00 62.50 15.29 409.79 ," I
<br /> 1 0/17/2007 ...,
<br />-- , - - , TOT~L " , $ 3 991.11
<br /> , , " ,,' ,/ , ---"_."..,-..,,;
<br />I' hereb that the Nebraska De artme evenue c m lied with-t n h tate of Neb ska,in-the determination of-the- .,.._~_.~~. "'
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<br />Y certify P fit of R , ,has 0 p he reve ue laws oft e S ra
<br />amount shown to be due; and the taxpayer has t3iled'to'paYJhe amount,due after demarid. IUhis Notice of Stale Tax lien is an extension of an
<br />. ~~ctille lien, it serves to co~tinue ~he pr.iority of tbes,tate's Interest in-the affected property of the taxpayer. '
<br />
<br />
<br />, Revenue Senior Agent
<br />Title '
<br />
<br />Revenue Supervisor
<br />Title
<br />
<br />01/23/2008
<br />Date
<br />
<br />308 3a5~6073-- .,
<br />Telephone Number
<br />
<br />. sign
<br />-here
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<br />01/23/2008
<br />Date
<br />4-49'10197<1 Rev. 2-2002 supersedes ......9-4'191<1 Rev_ 10-1995
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