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06/26/2009 FRI 15:36 FAX 402 471 4429 UCC SECRETARY QF STATE yyy Hall 002/003 <br />NE Sec pf S1•{e dohn A 6~r• <br />ucc sr4 <br />i., <br />Please forward to: <br />Nebraska Department of Revenue <br />4500 Ave I PO Box 1 S00 <br />Scottsbluff, NE 69363-1500 <br />2U~~0945233 <br />~ wnu~y <br />08/26/2009 01;41 plq <br />Nebraska bepartmen# of <br />R~~(~~ NOTICE OF STATE TAX LIEN <br />vvWW-revenue.ne.gov <br /> PLEASE WRITE IN THIS SPACE <br />This Notice of State lax lien is issued by the Nebraska Department of <br />Revenue for unpaid taxes pursuant tp 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 ac wired. <br />Nebraska Identi carton umber ede Identification Number <br />98754068 <br />L n Serial Number Lien lied Social Set~uity Number Spouse's Soda) Security Num <br />90720650 ®Register of Deeds County Clerk XXX-XX-8145 <br />Date o Lien flan Type County <br />06/24!2009 ®Clriginal QCor>bnuadon Corrected HALL <br />BUSINESS NAME AND LOCA TION ADDRESS TAXPAYER NAME AND MAILING ADDRESS <br /> JESHUA RUSSO <br /> 511 W CHARLES <br /> GRAND ISLAND NE 68803 <br />ax <br />Category Tax Period Data of Amount of Tax Penalty Interest Additions Balapca of <br />Number Assessment Assessment Dua <br />22 2005 03/13/2009 457.00 22.85 103.70 583.55 <br /> <br /> <br /> <br /> <br /> Tonal ~ ~ 583.55 <br />I ebv that the Nelxaska Det~ardrtent of Revenue as soma red with the revenue laws of ~e S e Netxaska in the determination of <br />amount shown to bed the taxpayer s failed to pay the amount due aRer demand. If this Notion of State Tax Lien is an ex~nsion of an <br />effective lien, it oontinu the p ' of state's interest In the affected property of the taxpayer. <br />r <br />Revenue Agent 06/24/2009 (308)fi32-120fi <br />sign s t t e ate elaphme um r <br />here ^ Revenue Supervisor 06/24/2009 <br />orixed Signa Title ~ ~ !?ate <br />4.481.1671 Rev. 2.1002 tiupereedee 1.491.1874 Rev.10~1685 <br /> <br />~~ <br />.... <br />. , .. . <br />- - - <br />