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10/06/2005 16:53 FAX 14024714429 NEBRASKA Dee 141 002/002 N~ s" of S~.~. J...." II ..1. . OCt n.. D4 9905416108-7 PlIlI: t NOREI'I ANTHONY T. FUed: 1 III I f1I6 I 2005 12: 16 PI'! 200510001 Please Return Original Copy to the Nebraska Dept. of Revenue at 200 South Silber, North Platte NE 69101 ' IIr n_.rill li_~ ,ot',~ NOTICE OF STATE TAX LIEN PLEASE DO NOT WRITE IN THIS SPACE This Notice of State Tax Lien is Issued by the Nebraska Department of Revenue for unpaid taxes pursuant to the revenue laws of the state of .. Nebraska. Notice is hereby given that taxes including penalties and ' interest, which are shown below, are due from the taxpayer specified below and remain unpaid after demand. These taxes constitute a lien in the county for real and personal property belongin'g to the taxpayer or hereafter aCQuired. Nebraska Identification Number Federal Identification Number 44095503 Lien Serial Number Lien Filed With Social Security Number Spouse's Social Security Number 43170066 ' 1KI Register of Qeeds.. 0 County Clerk 485-80-0502 Date of Lien Lien Type County ~original D Continuation o Corrected .., 1 0/03/2005 HALL. I BUSINESS NAME AND LOCATION ADDRESS TAXPAYER NAME AND MAILING ADDRESS r Business Name Name ANTHONY T. NOREM Street Address Street or Other Mailing Address 1823 W 3RD ST City State Zip Code City State Zip Code GRAND ISLAND NE 66803 I 'Tax I Category Tax Period Date of Amount of Tax Penalty Interest AddItions Balance of Number Assessment Assessment Due 22 2002. 09/28/2004 267.00 66.75 39.50 373.25 TOTAL $ 373.25 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 amount shown to be due, and the taxpayer has failed to pay the amount due after demand. If this Notice of Stafe ' Tax Lien i n extension of an effective lien, it serves to continue the priority of the stale's interest in the affected property of the taxpayer. [.. Revenue AQent 10 '':l~O? 308 535-8294 sign .. Title Date -Telephone Number here .. Revenue Supervisor /" - ""'-.0 1""- Title Date ~-494-1974 Rev. 2.2002 S~pa~8des ~-49".197" Rav. 10-1995 eD "