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<br />03/02/2009 HON 11:47 FAX 402 471 4429 UCC SECRETARY OF STATE 444 Hall <br /> <br />121002/006 <br /> <br />00 <br /> <br />Please forward to: <br />Nebraska Dept of Revenue <br />4500 Ave. I PO Box 1500 <br />Scottsbluff, NE 69363~1500 <br /> <br />200901536 <br /> <br />Ilrmllllll~"ll' <br /> <br />9909588426-6 Pg", 1 <br />PATTEN BRIAN F <br />Filed: 03/02/2009 08,48 AM <br /> <br /> <br />~. <br />NIlIobr....kIlI; O....._1lJt oC' <br /> <br />:REVENIUE <br /> <br />WWW.F......nU..n..Gav <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 /> . . <br />Revenue for unpaidtaxes pursu"nt to the revenue laws ofthe .8tate of . <br />Nebraska. Notice is hereby given that taxesinclud Ing penalties and <br />interest, which are. showilbelow, 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 /> 31595200 <br />Lien Serial Number Lien Filed With Social Security Numb~r Spouse's Social Security Number <br /> 90090245 [&I Register of Deeds DCounty Clerk XXX-XX-3755 <br />Date of lien Lien Type County <br />02127/2009 [&Joriginal OContlnuation o Corrected Hall <br />BUSINESS NAME AND LOCATION ADDRESS TAXPAYER NAME AND MAILING ADDRESS . <br />Business Name Name <br /> Brian F Patten <br />Street Address Street or Other Mailing Address <br /> 664 Faidley PI Apt 4 <br />City. ~tale Zip Code City State Zip Code <br /> Grand Island NE 68803 <br />Tax <br />Category Tax Period Date of Amountof Tax Penalty Interest Additions Balance of <br />Number Assessment Assessment Due <br />22 2006 12/04/2007 509.00 25.45 73.88 608.33 <br />22 2007 10/31/2008 571.00 55.55 37.08 663.63 <br /> TOTAL $ 1,271.96 <br /> <br />I hereby certify that the Nebraska Department of Revenue has compiled With the revenue laws of the State of Nebraska In the determination of the <br />amount shown to be d 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 seNe continue the pr, lty of the state's interest in the affected property of the taxpayer. <br /> <br />sign <br />here <br /> <br /> <br />Revenue Agent <br />Title <br /> <br />Revenue Supervisor <br />Title <br /> <br />02/27/2009 <br />Date <br /> <br />308 632-1200 <br />Telephone Number <br /> <br />02/27/2009 <br /> <br />Date <br />4-494-1974 Rev. 2.2002 Supersedes 4-494-1974 Rev. 10-1995 <br /> <br />G9 <br />