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<br />03/05/2008 WED 15:13 FAX 402 471 4429 UCC SECRETARY OF STATE ~~~ Hall <br /> <br />141002/006 <br /> <br />0' <br /> <br />200801885 <br /> <br />IIr <br /> <br /> <br />NOTICE OF STATE TAX, LIEN <br /> <br />f1a11rt$IIai' <br />.'IMI~I <br />..~ <br /> <br /> PLEASE DO NOT WRITE IN THIS SPACE <br />This Notice of State Tax Lien is Issued by the Nebraska Department of Imrlllrn r <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. 9908550440-0 Pss: 1 <br /> PATEL SUJATA V. - <br />Nebraska Identification Number Federal Identification Number Filed, e3/05/20ee 10:01 AM <br /> 9490779 <br />Lien Serial Number Lien Filed With Social Security Number Spouse's Social Security Number <br />112 OO~Oo 4 ~ IKI Register of Deeds D County Clerk XXX-XX-5804 <br />Date of Lien Lien Type County <br /> 03/01/2008 ~ Original D Continuation o Corrected HALL <br />I BUSINESS NAME AND LOCATION ADDRESS TAXPAYER NAME AND MAILING ADDRES~ 1 <br />Business Nam,e Name <br /> SUJATA V. PATEL <br />Street Address Street or Other Mailing Address <br /> 2214 COTTAGE STREET <br />City State Zip Code ' City State Zip Code <br /> GRAND ISLAND NE 68803 <br />r Tax <br />Category Tax Period Date of Amount of Tax Penalty Interest Additions Balance of <br />Number Assessment Assessment Due <br />01 06/01/2006 02/08/2008 . 535.00 53.50 63.99 652.49 <br /> 06/30/2006 . <br />68 06/01/2006 02/08/2008 584.99 66.32 69.14 720.45 <br />06/30/2006 <br /> . <br /> TOTAL $ 1,372.94 <br /> <br />sign .. <br />here Ii>- <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 aflerdemand. If this Notice of State <br />Tax Lien Is a ension of an ive lie . it serves to continue the priority of the state's interest in the affected prope,rty'of the taxpayer. <br /> <br />Revenue Agent 0l..-0l7~O% 402471-5711 <br /> <br />Title Date Telephone Number <br /> <br />'j..3-Of <br />Date <br /> <br /> <br />Revenue Senior Agent <br />Tille <br /> <br />4-494-1974 Rsv, 2-2002 Supsr58d8s4"'94~1974 Rev. 1D-1995 <br />V <br />