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<br />db"!2008 <br /> <br />TUE 15:02 <br /> <br />FAX 402 471 4429 UCC SECRETARY OF STATE ~~~ Hall <br /> <br />12100.2/007 <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 />11111"1111 <br /> <br /> <br /> <br />HANSEN TIMOTHV A Pes: 1 <br />Filed, 04/15/2008 10:52 AM <br /> <br />200803138 <br /> <br /> <br />~ <br />N..br....k. 0_...<1""",n1; o~. <br /> <br />REVENUE <br /> <br />www........n"'.;."...(jiO''Y' <br /> <br />NOTICE OF STATE TAX LIEN <br /> <br /> PLEASE DO NOT WRITE IN THIS SPACE L <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 :".1 <br /> .; -: ~'I' ' <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' Federal Identification Number <br /> 9213783 <br />Lien seria~;:r~~d nn W Lien Filed With Social Security Number Spouse's Social Security Number <br />[&JRegister of Deeds Dcounty Clerk . XXX-XX-5737 <br />Date of Lien ; . Lien Ty~ County. <br /> ., <br /> 04/07/2008 . . ,OOoriQinal . DContinual!on, : 'DCo~r~.cted,. Hall <br /> .' <br />BlISINESS NAME AND LOCATION ADDRESS " , . , . . ,TAXPAYER NAME AND MAILING'MDRESS ' <br />Business Name Name <br /> Timothy A Hansen <br />Street Address Street or Other Mailing Address <br /> 114 Stellar Street <br />City State Zip Code City State Zip Code <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 />01 05/01/2005- 04/22/2007 11,892.16 2,296.50 1,894.54 16;083.20,: .. <br /> 06/06/2006 .'" <br /> _n' <br /> . . .. <br /> . . <br /> . ... <br /> TOTAL $ 16,083.20 <br /> ',' . .... . <br /> . . ,. <br /> <br />. " <br /> <br />. I hereby certify that the Nebraska Department of Revenue has compli.ed with the revenue .!awsof the State of Nebraska in the.determlnallon of the <br />amounl shown to be due, and the taxpayer has failed to pay the .amount due after demand. If this Notice of State Tax Lien is an extension of an <br />effective lien, it serves to contin the riority of the state's interest in the affected property of the taxpayer. ,,/ <br /> <br />Revenue 'Senior Agent4jl) ) ).,fJ/) ~ 308 385.s073 <br />Title Date Tele~,ne Number <br /> <br />Revenue SuperviSor 0#' JI <br />Title <br />'1-49,"'974 Rev. 2-2002 Supersedes 4-494-1974 Rev, 10-1995 <br /> <br />sign <br />here <br /> <br /> <br />0., <br />..,'.' ) <br />