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07/02/2009 THU 15:18 FAR 402 471 4429 UCC SECRETARY OF STATE -~~~ Hall <br />~~ <br />Please forward to: <br />Nebraska Department of Revenue <br />4500 Ave I PO Box 1500 <br />Scottsbluff, NE 69363-1 S00 <br />200905407 <br /> <br />N!a rawka ~ApirRctrsr7k o! <br />~~~E <br />rp1 w W . r rY Ir a1 rair. in ~. p eAr <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 />ar hereafter acquired. <br />16917456 <br />972620045 Register of Deeds [county clerk XXX-X)0264 <br />'Date of Lien L(en Type County <br />07/21/1999 ~Originel ~X Continuation QCbrrected Hall <br />BUSINESS NAME AND LOCATIt7N ADDRESS TAXPAYER NAME AND MAILING ADDRESS <br />Category Tax Period Date of <br />Number Assessment <br />22 1996 ' 07/01 /1997 <br />Amount of Tax <br />k~~,y~ <br />~Fi7e_ <br />X002/005 <br />NE S.e ai LF.~a Jahn R Gala UCC 5[ON <br />-,.~%' <br />9909601129-4 Ppa: 3 <br />F~adEW07%02l2009L08;55 AM <br />NOTICE OF STATE TAX LIEN <br />Michael B Czaplewski <br />t or Other ailing Address <br />16669 Read Road <br />State <br />Honey Creek Iowa <br />Penalty Interost Additions <br />799.87 <br />48.99 I 171.22 <br />51542 <br />Balance of <br />Assessment Due <br />1,020A8 <br />TOTAi. ~ $ 1,020.08 <br />~~F~R.,r ~~u~r u~a< <~~a ~•a~~a~~ uespanmen[ yr revenue nas compneo wrtn the revenue laws of the State of Nebraska in the dBtermination 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 Ilan, it serves to continue the priority of the state's interest in the affected property of the taxpayer. <br />Grid t Martin TSS ~ l `~ ~ DQI 308 632-1200 <br />Slgrl Pr a _ tie Date elephon Num r <br />here ~ Revenue Su ervisor f <br />uthorize gnature Title pa <br />4194-7974 Rav. 2-2002 Supersedes 4494-197 Rav. 70. <br />SEE ATTACN~~.~TS <br /> <br />