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<br />11/12/2008 WED 15:43 FAX 402 471 4429 UCC SECRETARY OF STATE ~~~ Hall <br /> <br />121002/004 <br /> <br />Please forward to: <br />Nebraska Dept of Revenue <br />4500 Ave I PO Box 1500 <br />Scottsbluff, NE 69363-1500 <br /> <br /> <br />9908575588-1 <br />LANTZER SUSAN A <br />Filed: 1111212008 11:20 AM <br /> <br />\P <br /> <br />200809421 <br /> <br /> <br />~. <br />N..br....k.. D~l"I'I: all" <br /> <br />:REVENUE <br /> <br />W....W.If.....hu..n..._' <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 rev.,nue laws of the state of <br />Nebraska. Notice is hereby given that taxes Including p,enalties 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 /> 43243266 <br />Lien Serial Number Lien Filed With Social Security Number lspouse's Social Security Number <br /> 62008017 [!I Register of Deeds DCounty Clerk XXX-XX-7292 <br />Date of Lien Lien Type County <br /> 11/06/2008 I!IOriginal DContlnuation Dcorrected Hall <br />I BUSINESS NAME AND LOCATION ADDRESS TAXPAYER NAME AND MAILING ADDRESS <br />Business Name Name <br /> Susan A Lantzer <br />Street Address Street or Other Malling Address <br /> 1805 N Highway 14 <br />City ::itate Zip Code City State Zip Code <br /> Aurora NE 66818 <br />Tax <br />Category Tax Period Date of Amount of Tax Penally Interest Additions Balance of <br />Number Assessment Assessment Due <br />22 2003 09/14/2006 1,209.09 60.45 448.66 1,718.20 <br /> TOTAL $ 1,718.20 <br />I hereb certi that the Nebraska De arlment of Revenue has com lied with the revenue laws of the State of Nebraska in the determination of the <br /> <br />y fy <br />amount shown to be <br />effective lien, it serve <br /> <br />sign <br />here <br /> <br /> <br />p p <br />, and the laxpay has failed to pay the amount due after demand. If this Notice of Slate Tax LIen is an extension of an <br />. rity of the state's interest in the affected property of the taxpayer. <br /> <br />Revenue Agent <br />Title <br /> <br />Revenue Supervisor <br />Tille <br /> <br />11/06/2008 <br />Date <br /> <br />308 632-1200 <br />Telephone Number <br /> <br />11/06/2008 <br />Date <br />4-4904.1974 Rev. 2.,2002 Supersede" 4.0494-1974 Rev. 10-1995 <br /> <br />v <br />