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07/08/2009 WED 15:05 <br />0 <br />FAX 402 471 4429 UCC SECRETARY OF STATir ~~~ Hall <br />Please forward to: <br />Nebraska Department of Revenue <br />4500 Ave T PO Box 1500 <br />Scottsbluff, NE 69363-1500 <br />• a,..~... ,. <br />200905550 <br />X004/005 <br />N6 Sac of Sk~k~ Jahn A Oel^ VG[ STL <br />ss®s6ai5i®-a Per: 1 <br />WRITTEN NORMAN L JR <br />Filmd: 07/08/2009 10:29 RM <br />Nebraska Department of <br />REVENUE NOTICE OF STATE TAX LIEN <br />www-revenue-ne.gov <br />This- Notice of State Tax Lien is issued by the, Nebraska Department of <br />Revenue for unpaid. tapes ~pr,~uapt.~ tF.tt1: tevsnue 1,~. - <br />Nebraska. Notice is hereby given that taxesAinchiding penaltietl 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 belgnging to the taxpayer <br />or hereafter acquired. <br />20773439 <br />80810067 <br />®Register of Deeds County <br />XXX-XX-7537 I XXX-XX-9671 <br />07/Ofi/2009 ®Original ~Continuatlon ~Conected HALL <br />BUSINESS NAME AND LOCATION ADDRESS TAXPAYER NAME AND MAILING ADDRESS <br />NORMAN L & PENNY P WRITTEN JR <br />912W5THST <br />GRAND ISLAND NE 68801-0412 <br />Category Tax Period Date of Amount of Tax Penalty Interest Additions Balance of <br />Number Assessment Assessment Due <br />22 2005 03121/2008 581.00 74.20 3D8.89 963.89 <br />TOTAL I $ 963.89 <br />: nerecry cerury u:a: me rverxasica ueparunem or rcevenue nos cornp~~ea Mntn the revenue laws or the state of Netxasxa m the determination of the <br />amount shovm to be ,and fire taxpay r has failed to pay the amount due after demand- If this Notice of State Tax Lien is an extension of an <br />effective lien, its to continue the 'ty of the state's interest in the affected property of the taxpayer. <br />~ Revenue Agent O7/OBl2p09 (308)632-1206 <br />S 1~ r1 ~gnahK Tide Date Telephone Number <br />here ^ ~~r~~y~,y,~ ~;,p,~ eta oTlas/zoo9 <br />arized Sign ure Title Date <br />491-1971 Rov. Z-2002 Supersedes 4-494-1971 R~v.10.1995 <br /> <br />