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<br />05/15/2009 FRI 14:33 FAX 402 471 4429 UCC SBCRBTARY OF STATB ~~~ Hall <br /> <br />~002/006 <br /> <br />~ <br /> <br />-tltfJr <br /> <br />.:, ~ <br /> <br />:tif~; <br /> <br /> <br />Please forward to: <br />Nebraska Dept of Revenue <br />4500 Ave. I PO Box 1500 <br />Scottsbluff, NE 69363-1500 <br /> <br />200903780 <br /> <br /> <br />-~ <br />......br...k. O_nnMnt alf <br />iREVENUE <br /> <br />'lNww.II'.....""U..Il'l;..'lll...... <br /> <br />NOTICE OF 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 ae uired. <br />ebraska Identification umber Federal Identification Number <br />26132850 <br /> <br />PLEASE DO NOT WRITE IN THIS SPACE <br /> <br />en Serial Number <br /> <br />Lien Filed With Social Secunty umber <br />I!IRegister of Deeds DCounty Clerk XXX-XX-3354 <br />Lien Type <br />05/12/2009 OOOriginal Dcontinuation <br />BUSINESS NAME AND LOCATION ADDRESS <br /> <br />Spouse's Social Security Number <br /> <br />90230041 <br /> <br />Date of Lien <br /> <br />County <br />DCorrected Hall <br />TAXPAYER NAME AND MAILING ADDRESS <br /> <br />TOTAL <br /> <br />$ <br /> <br />9,453.58 <br /> <br />... <br />sign <br />here ... <br /> <br /> <br />Revenue Agent <br />Title <br /> <br />Revenue Supervisor <br />Title <br /> <br />05/12/2009 <br />Date <br /> <br />308 632-1200 <br />Telephone Number <br /> <br />raska Department of Revenue has complied with the revenue laws of the State of Nebraska in the determination of the <br />amount shown to be du. d the taxpa as failed to pay the amount due after demand. If this Notice of Stale Tax lien is an extension of an <br />conti u the p' ty of the state's interest in the affected property of the taxpayer. <br /> <br />05/12/2009 <br /> <br />Date <br />.....94-1974 Rev_ 2.2002 Supersedes 4-494.1974 Rev_ 1(}.1995 <br /> <br />\// <br />