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<br />01/21/2009 WED 15:21 FAX 402 471 4429 UCC SECRETARY OF STATE ~~~ Hall <br /> <br />121005/005 <br /> <br />00 <br /> <br />NI lu of Sh'e J"h... II G..I. . UCC SCON <br /> <br /> <br />200900378 <br /> <br />9909584264-8 P\ils: 1 <br />EGGERS LAURA <br />Filed: 01/21/200902:17 PM <br /> <br />"!- <br /> <br /> <br /> <br />F STATE TAX LIEN <br /> <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 />32904630 <br /> <br />08/16/1999 <br /> <br />Lien Filed With <br />I!I Register of Deeds <br />Lien Type <br />DOriginal OOContinuation <br /> <br />Social Security Number <br />OCounty Clerk XXX-XX-5880 <br /> <br />Spouse's Social Security Number <br /> <br />Lien Serial Number <br /> <br />991620161 <br /> <br />Date of Lien <br /> <br />County <br />o Corrected HALL <br /> <br />TAXPAYER NAME AND MAILING ADDRESS <br /> <br />BUSINESS NAME AND LOCATION ADDRESS <br />Business Name <br /> <br />Name <br />LAURA EGGERS <br />Street or Other Mailing Address <br />RT 5 BOX 550. <br /> <br />Street Address <br /> <br />CANTON <br /> <br />State <br />TX <br /> <br />Zip Code <br />75103 <br /> <br />City ae Zip Code <br />Tax <br />Category Tax Period Date of Amount of Tax <br />Number Assessment <br />22 1995 04/27/1999 310.00 <br />22 1996 07/23/1999 396.00 <br /> <br />City <br /> <br />Penalty <br /> <br />Interest <br /> <br />Additions <br /> <br />Balance of <br />Assessment Due <br /> <br />15.50 <br /> <br />93.1'0 <br /> <br />418.60 <br /> <br />19.80 <br /> <br />83.29 <br /> <br />499.09 <br /> <br />TOTAL <br /> <br />$ <br /> <br />917.69 <br /> <br />I hereby certify that the Nebraska Department ot Revenue has complied with the revenue laws of the State of Nebraska in the determination 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 servjto conti?ue ~ priority of the state's interest in the affected property of the taxpayer. . <br /> <br />. .... ~<<VU ~ REVENUE AGENT 01/15/2009 402 471-5928 <br />sign Preparer's Signature Title Dale Telephone Number <br /> <br />here ... REVENUE AGENT SUPERVISOR 01/15/2009 <br />Title Date <br />4-494-1974 RlIv. 2.2002 Supersedes 4-494.1974 Rev. 10-1995 <br /> <br /> <br />.0P <br />