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<br />08/18/2008 MON 15:02 FAX 402 471 4429 UCC SECRETARY OF STATE ~~~ Hall <br /> <br />1dI003/005 <br /> <br />~, <br /> <br />Please fOIWard to: <br />Nebraska Dept of Revenue <br />4500 Ave I PO Box 1500 <br />Scottsbluff, NE 69363-1500 <br /> <br /> <br />9908568645-4 Pgs: 2 <br />MCCARTNEY CONNIE L <br />Filed: 08/18/2008 11:08 AM <br /> <br />200807199 <br /> <br /> <br />~ <br />IN.,br....k. o_'"'rtrnoent 01 <br /> <br />REVENUE <br /> <br />WWW.f.......l!I....lIII.n....o"".. <br /> <br />NOTICE OF STATE TAX LIEN <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. 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 taxpayer <br />or hereafter aCQuired. <br />Nebraska Identification Number Federal Identification Number <br /> 16048245 <br />Lien Serial Number Lien Filed With Social Security Number Ispouse's Social Security Number <br /> 992250519 r&!Register of Deeds DCounty Clerk XXX-XX-9499 XXX.XX.4096 <br />Date of Lien Lien Type County <br /> 10/26/1999 DOriginal ~Continuation DCorrected Hall <br />BUSINESS NAME AND LOCATION ADDRESS TAXPAYER NAME AND MAILING ADDRESS <br />Business Name Name <br /> Connie L & Mary C McCartney <br />Street Address Street or Other Mailing Address <br /> 1616 S Lincoln <br />City titate Zip Code City State Zip Code <br /> Grand Island NE 68801 <br />Tax <br />Category Tax Period Date of Amount of Tax Penalty Interest Additions Balance of <br />Number Assessment Assessment Due <br />22 1998 OS/28/1999 1,500.00 93.00 44.38 1,637.38 <br /> TOTAL $ 1,637.38 <br /> <br />I hereby certify that the Nebraska Department of Revenue has complied With the revenue laws of the State of Nebraska In the determinallon of the <br />amount shown to be d and the taxpayer s failed to pay the amount due after demand. If this Notice of State Tax Lien is an extension of an <br />effective lien, it serve continue he pri . y of th state's Interest in the affected property of the taxpayer. <br /> <br />... <br />sign <br />here ~ <br /> <br /> <br />Revenue Agent <br />Tille <br />Revenue Senior Agent <br />Tille <br /> <br />08/14/2008 <br />Date <br /> <br />308 632-1200 <br />Telephone Number <br /> <br />08/14/2008 <br />Date <br />4-494-1974 Rev. 2stt~rrA-eJ:irvrE~fs <br /> <br />fJ <br />