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09/08/2009 TUE 14:39 FAX 402 471 4429 UCC SECRETARY' OF STATE ~yy Hall <br />~~ <br />Please forwazd to: <br />Nebraska Department of Revenue <br />4500 Ave I PQ Sox 1500 <br />Scottsbluff, NE 69363-1500 <br />200907373 <br />~ooz/onz <br />i1°~~n.~ ealy uCC STL <br />KISTLEa JOHN A P8~' t <br />Filed: 09108/26p9 02;38 Pp <br />Nebraska Department of <br />REVENUE NOTICE OF STATE TAX LIEN <br />www.revanue.ne.gov <br /> L T A E <br />This Notice of State Tax Lien is issued. by the Nebraska Department taf , <br />.Revenue for~utlpaid taxes pursuant to the reirenue laws of the state of <br />Nebraska. Notice is hereby givetr'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 uired. <br />Nebraska Identi cation umt~er Federal Identi6caGon umtter <br />38955180 <br />Lien Serial Number Lien Flied With Soda) Seaxity Number pouse's 'e Security Number <br />090090437 ®Regisler of Deeds County Clerk XXX-XX-0303 XXX-XX-5590 <br />Date of lien Lien Type aunty <br />09/04/2009 ~ Original ~Corrtlnuation QCorrected HALL <br />BUSINESS NAME AND LOCA TION ADDRESS TAXPAYER NAME AND MAILING ADDRESS <br /> JOHN A & TRACY D KISTLER <br /> PO 60X 1244 <br /> GRAND ISLAND NP 8B$02-1244 <br />ax <br />Category Tax Period Date of Amount of Tax Penalty Interest Additions Balance of <br />Number Assessment Assessment Due <br />22 2006 05!23/2007 168.63 14.80 32.23 215.86 <br />22 2007 10/31/200$ 498.00 24.90 45.23 568.13 <br /> <br /> <br /> <br /> TOTAL $ 783.79 , <br />I hereby certif y that the Nebras ka Department of Revent~ as complied w i a revenue law s of the State of Nebraska in the d etermination <br />amount stxnnrtt to be ue, and the r has tailed t4 pay the amount due after demand. If this Notice of State Tax Lien is an extension of an <br />effective I"ran, its to con 'nue 'ty the state's interest in the affected property of the taxpayer. <br />Revenue Agent 09/04/2009 (308)632-1206 <br />slgrl re s r oat rqe ~~~~ cep Number <br />here ^ (}~[ o9/oarzaoa <br />Authorized Signature Tie Gate <br />~-494197' Rev. &YOtf2 supersedes 1•~9~1974 Rev. 141985 <br /> <br />