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10/09/2009 FRT 14:42 }?AX 4pZ 471 4429 IlCC SECRETARY OF STATE ~~y Hall <br />200908158 <br />Please forward to: <br />Nebraska Department of Revenue <br />4500 Ave I PO Box 1500 <br />Scottsbluff, NE 69363-1500 <br />N~ ska Department of <br />~vENUE <br />www-revenue.ne.gov <br />X002/002 <br />a.re_- uee sr~ <br />~~a~o~-n Pqs : t <br />MEYERS JOHN C <br />F11ed: 10/09/2009 10:50 AM <br />NOTICE OF STATE TAX LIEN <br /> DO 0 IT IN THIS SPAC <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 spacifled <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 Idenn canon Number F dens bon Number <br />23916605 <br />Lien Sen Number Lien Fil i my Number Spouse's Saq -ty Number <br />1093D275 ®Register of Deeds ~Caunty Clerk XXX-XX-3172 XXX-XX-1248 <br />Date of Lien Lien Type only <br />10/06/2009 ®Original ~Connnuannn C]Corrected HALL <br />BUSINESS NAME AND LOCA TION ADDRESS TAXPAYER NAME AND MAILING ADDRESS ' <br /> JOHN C & SUSAN M MEYPRS <br /> 11070 S BUFFALO ROAD - <br /> DONIPHAN NE 68832 <br />Tax <br />Cabgory Tax Poriod Date of Amount of Tax Penplty Interest Additions Balance of <br />Number Assessment Assessment Due <br />22 2003 D5/25/2007 720.00 204.00. 260.05 1,184.05 <br />22 20D5 04105/2009 686.36 171.59 165.54 1,023.49 <br /> <br /> <br /> <br /> TOTAL $ 2,207.54 <br />I her certify that the Nebras ka t of Revenue as complied with a revenue laws the too braska in the determination of the <br />amount ahOVln t0 be duerand t he taXllaver has f ailed to aav the amount due ARPr rlpmanrt Ir Fhic Nntira of Staia Tav 1 ian is an avtancinn „f ~~ <br />effective lien, it serves aonnn a the - -ly of the stake's interest in the affected property of the taxpayer. _ <br />Revenue Agent 10/06/2009 (308)632-1206 <br />sign s "gnatu a Date Telep umber, <br />here ^ Revenue Su eroisor 1D/D6/2oD9 <br />5- re line Date <br />4de~-187 Rev. 2-2402 Supersedes 4-49A-197 Rev. t4.7B85 <br />