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<br />03/07/2008 FRI 15:12 FAX 402 471 4429 UCC SECRETARY OF STATE ~~~ Hall <br /> <br />l2I002/002 <br /> <br />,~ <br /> <br />Please return to: <br />8T A TE OF NEBRASKA <br />DEPARTMENT OF REVENUE <br />1811 WEST 2ND 8T STE 460 <br />GRAND ISLAND NE 68803 <br /> <br />200801918 <br /> <br />" <br /> <br /> <br />-~ <br />iN........,..... O_"',",",-'''M.II <br /> <br />REVENUE <br /> <br />wv..ww..-..............O.',...Q10V <br /> <br />NOTICE OF STATE TAX LIEN <br /> <br />ThiS Notice of State Tax Lien is issued by the Nebraska Department of <br />Revenue for unpaid taxes pursuant tathe revenue laws of the state of <br />Nebras.ka. 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 tax'payer <br />or hereafter ae uired. <br />Nebraska Identffi~tion Number <br /> <br /> <br />9898085 <br /> <br />32-0186623 <br /> <br /> <br />03/05f2008 <br /> <br />Lien Filed With <br />00 Register of Deeds <br />Lien Type <br />[&IOriQinal DContinuation <br /> <br />Social $ecurity Number <br />OCounty Clerk )9<X-XX-9651 <br /> <br />Spouse's Social Security Number. <br /> <br />DCorrected <br /> <br /> <br />Hall <br /> <br />Date of Lien <br /> <br />BUSINE$S,NAME ANP LOCATION ADDRESS <br />Business Name <br /> <br />- - TAXPAYER NAME AND MAILING ADDRESS <br />Name. . _', <br />,David M Martin <br />Street or Other Mailing Address <br />808 West Division <br /> <br />Street Address <br /> <br />Grand Island <br /> <br />State' <br />NE <br /> <br />Zip Code <br />68801 <br /> <br />City ae Zip Code <br />Tax <br />Category Tax Period Date of Amount of Tax <br />Number Assessment - <br />01 12/15/2006. 07/03/2007 2,472.34 <br />OS/21/2007 <br />21 01101/2007- 01/27/2008 300.00 <br />OS/21/2007 <br /> <br />City <br /> <br />Penalty <br /> <br />Interest <br /> <br />Additions <br /> <br />Balance of <br />Assessment Due <br /> <br />228.29 <br /> <br />175.81 <br /> <br />75.00 <br /> <br />18.38 <br /> <br />2,876.44 <br />393.38 . <br /> <br />TOTAL <br /> <br />$ <br /> <br />3,269.82 <br /> <br />. I. hereby certify that the Nebraska Department of Revenue has complied with the revenue laws of the State of Nebraska in the determination of the <br />; amount shown to be due; and tlie taxpayer has failed to pay the amount due atterdemand..lfthis Notice of State Tax lien is an extension of an <br />effective lien, it serves. to con ue the priority of the state's interesl in the affected property of the taxpayer. <br /> <br />0/q~()/)/ <br />Date <br /> <br /> <br />Revenue Senior Agent <br />Title <br /> <br />308 385.,6073 <br /> <br />Telephone Number <br /> <br />r0r <br />o e, <br /> <br />Revenue Supervisor <br />Title <br /> <br />4-494-1974 Rev. 2-2002 Supersedes 4-494-1974 Rev. 10-1995 <br /> <br />\V <br />