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07/22/2009 PTSD 15:06 FAX 402 471 4429 ^CC SECR}3TA1tY OIL STATE y~y Hall O~ 200906021 Ar~ebrgski ~i,v~rlrlnbWt 8! ~~~'~~ W YYYV.M eW ^nur.~h~.~awv X003/005 NE SRC of 54a4e ]ohn p 4r1• - l1CC STL 990960X745-1 Psi: i WINTER DOUGLAS C Filed: 07!22/2008 09:02 Afl NOTICE OF STATE TAX LIEN This Notice of State Tax Lien is issued by the Nebraska Department of Revenue for unpaid taxes pursuant to the revenue laws of the state of Nebraska. Notice is hereby given that taxes including penalties and interest, which are shown below, are due fram the taxpayer specified belaw and remain unpaid after demand. These taxes constitute a lien in the caunty for real and personal property belonging to the taxpayer or hereafter ac uired. a reeks dent icatlon umber Federal Identificatia 5889715 0~ 3 Register of Deeds County Clark XXX-XX-2485 Date o en Lien Type County 0$/28/20.08 ^X Original ~ConUnuation ~Comected HALL ..... . BUSINESS NAME=AND LOCATION ADDRESS TAXPAYER NAME AND MAILING ADDRESS " Business Name Name DOUGLAS C WINTER Street Address trpet or Ot er Mailing Address 4$79 N ST PAUL RD City a e Zip Code ity State Zip Code r~a7ntin tet nntn r,i~ 606114 Tax - ---- Category Tax Period Date of Amount of lax Penalty Interest Additions Balance of Number Assessment Assessment Due 01 "'""'""""" 08/01/2006 894.95 179.00 , 168.89 1,242.84 12/31 /2005 01 01/01/2006- 07/01!2007 1,120.00 224.00 142.62 1,486.62 12/31/2006 01 01/01/2007- 07/07/200$ 1,400.00 280.00 86.28 1,746.28 12/31/2007 TOTAL ~ $ 4,475.74 ~~~~~~~ .,~.~~~r ~~~a~ ~~~Q ~.a~lp~l.p ucpnlunCln yr 1levenus nas wmpnea wrtn me revenue laws of the State of Nebraska in the determination of the amount shown to be due, and the taxpayer has failed to pay the amount due alter demand. If this Notice of State Tax Lien is an extension of an effective lien, it serves to continue the priority of the slate's interest in the affected property of the taxpayer. - aoz Silgn Teleph ne u er here ` oZd Date ea A~94-1974 Rev. ta1995 h , -