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11/10/2009 TU13 15:05 FAX 402 471 4429 UCC SEC1tETARX OF STATE ~~~ Hall 1004/005 <br />o~ <br />~oososs~o <br />Please return Copy to: <br />Nebraska Dept of Revenue <br />PO Box 9481 S <br />Lincoln NE b$509 <br />NE Sec e1 Sk+l+ John P G+1a UCC 57L <br />9909611775-5 Pgs: 1 <br />TERRY DpRYL l_ <br />Filed: 11/10/2009 12:02 PM <br />Nebraska Department of <br />REVENUE NOTICE OF STATE TAX LIEN <br />www.revenue.ne.gov <br />This Notice of State Tax Lien is issued by the Nebraska Department of <br />Revenue for unpaid taxes pursuant to the revenue laws of the state of <br />Nebraska. Notice is hereby given that taxes including penalties and <br />interest, which are shown below, are due from the taxpayer specified <br />below and remain unpaid after demand. These taxes constitute a lien <br />in the county far real and personal property belonging to the taxpayer <br />or hereafter acquired. <br />44632606 <br />1093194fi ®Register of Deeds ~Counry Clerk XXX-XX-4766 XXX-XX-5234 <br />]ate of Uen Lien Type aunty <br />11/06/2009 ®t]riginal ContinuationCorrected HALL <br />BUSINESS NAME AND LOCATION ADDRESS TAXPAYER NAME AND MAILING ADDRESS <br />DARYL L TERRY <br />1347 WEST 8TH STREET <br />ERIE PA 16502 <br />Category Tax Period Date of Amount of Tax Penalty Interest Additions Balance of <br />Number Assessmont Assessment Due <br />22 2D05 12/11/2008 31$.3D 15.92 7$.11 412.33 <br />TOTAL ~$ a1z_a3 <br />..._. __, _~,.., ...~ ............. W,,,.a „~,,a,,,,,~,,, ~, ncvni iuC nos ~ampnea wlul me revenue taws or the Stale of Nebraska in the determination of the <br />amount shown to be due, and the taxpayer has faded to pay the amount due after demand. If this Notice of State Tax Lien is an extension of an <br />effective lien, it se s to continue the priority of the state's interest in the affected property of the taxpayer. <br />Revenue Agent 11/06/2009 (4D2)471-5928 <br />sign ep rer's rgna nr Title Date Telephone umber <br />here ^ Revenue Su ervisor lvos/zoo9 <br />thorized Signal a Title pate <br />4494-1974 Rev. 2-2002 Supersedes 4.484.1874 R+r.10.1995 <br /> <br />