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<br />05/12/2008 MON 15:27 FAX 402 471 4429 UCC SECRETARY OF STATE ~~~ Hall <br /> <br />b% <br /> <br />Please return to: <br />STATE OF NEBRASKA <br />DEPARTMENT OF REVENUE <br />1811 WEST 2ND S1 STE 460 <br />GRAND ISLAND NE 68803 <br /> <br />~002/002 <br /> <br /> <br />1111""" <br /> <br /> <br />K~LrNLe: SAID 7 Pss: 1 <br />Fl!ed: 06/12/2008 11:27 AM <br /> <br />200804118 <br /> <br /> <br />~. <br />._....." ...:.,.:.....::..............,g____..c..... '''''''''.~_..:. .,_...____-'.___._...:."-'--_..._._.,.-'-.__..._...:._........_,...._ <br />. REVENUE . NOTICE OF STATE TAX LIEN" <br /> <br />www......................O_ <br /> <br /> PLEASE DO NOT WRITE IN THIS SPACE <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. N'otlce 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. .. .. <br />Nebraska Identification Number Federalldentlficatlon Number <br /> 9996907 <br /> . . <br />Lien seriO~rer :/1 Lien Filed With Social Security Number Spouse's Social Security Num~er <br /> 'tJ 8 ~ nD?:>D 00 Register of Deeds DCounty Clerk XXX-XX-1982 <br />Date of Lien · Lien Type County <br /> 05/09/2008 OOOriQinal Dcontinuation DCorrected Hall <br />I 'BUSINESS HAM!; 'AND LOCATtON ADD~ESS TAXPAYER NAME AND MAIUNG ADDRESS <br />BusinesS Name '. - I IName <br /> Said Kalinle <br />Street Address Street or Other Mailing Address <br /> 118 S Vine Street .~i <br />City ::state Zip Code City State Zip Code <br /> Grand Island, NE 68801 <br /> TalC .--- <br /> CategorY TalC Period Date of Amount of Tax Penalty Interest Additions Balance of <br /> Number Assessment Assessment Due <br /> 01 04/01/2007. 0;3/06/2008 674.00 292.50 33.65 1,000.15 <br /> 12/31/2007 <br /> 21 04/01/2007- 03/06/2008 75.00 75.00 3.05 153.05 <br />, 12/31/2007 <br /> , <br /> -...-..-....,. <br /> .' <br /> .. . ~;1~~ I}'. <br /> TOTAL $ 1,153.20 <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 /> <br />amount 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 serv to continue the priority of the state's interest in the affected property of the t~ayer. . <br /> <br />.. ... . Revenue Senior Agent Y ?j ~/').1 308385-6073 <br />sign Preparer's Signatu~re I Tille Date Telephone Number <br /> <br />here ... /\ ~_.~ _~ Revenue Supervisor s7~y <br />~~ I~~ ~ ~ <br />4-<194.1974 Re~. 2-2002 SUp"I'$8des 4-<194-1974 Re~.10.1995 <br /> <br />-\0 <br /> <br />j <br />