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<br />05/13/2008 TUE 15:09 FAX 402 471 4429 UCC SECRETARY OF STATE ~~~ Hall <br /> <br />1dI002/002 <br /> <br />~ <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 /> <br />200804163 <br /> <br /> <br />~ <br />N...b,.~k.. D_~r1",'Ilo...t 1Ilo~ <br /> <br />REVENUE <br /> <br />www .~..""."UCl'..I.". uO-"V <br /> <br />NOTICE OF STATE TAX LIEN <br /> <br /> PLEASE DO NOT WRITE IN THIS SPAce- <br />This Notice QfState 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 induding 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 th~ county for real and personal property belong,ing to the taxpayer <br />or hereafter acquired. <br />Nebraska Identification Number Federal Identification Number <br /> 6854397 <br />Lien Srnr~gl ()()3 f Lien Filed With Social Security Number Spouse's Social Security Number <br />[gJ Register ot Deeds Ocounty Clerk, XXX-XX-9506 <br />Date of Lien Lien Type County . <br /> 05/08/200B OOOriginal Dcontinuation o Corrected Hall <br />BUSINESS NAME AND LOCATION ADDRESS TAXPAYER NAME AND MAILING ADDRESS <br />Business Name . Name <br /> . Lee W Culbert <br />Street Address Street or Other Mailing Address <br /> POBox 5323 - <br />City ~tate Zip Code' City State Zip Code <br /> Grand Island NE 68802 <br />Tax ,_., , <br />CategolY Tax Period . Date of Amount of Tax Pemllty Interest Additions Balance of <br />Number Assessment Assessment Due <br />01 10/01/2007- 02/05/2008 415.59 41.56 9.47 466.62 <br />12/31/2007 <br /> TOTAL $ 466.62 <br /> <br />I hereby certify that the Nebraska Department of Revenue has complied with the revenue laws of the State of Nebraska m the determmallon of the <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 serves con inue th priori of the state's interest in the affected property of the taxpayer. <br /> <br />.s;/~/~I'J()' <br />Date <br /> <br />sign <br />her, <br /> <br /> <br />Revenue Senior Agent <br />Tille <br /> <br />308 385-6073 <br /> <br />. Revenu~ Supervisor <br />. Title - <br /> <br />Telephone Number <br /> <br />;1.2/a ~ <br />o I <br />4-4901-1974 Rev. 2-2002 Supersedes 4-494-1974 ROllI. 10.1995 <br /> <br />m~ <br /> <br />) <br />