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12/01/2009 TUE 14:18 8AX 402 471 4429 UCC SECRETARY CF STATE yyy Hall <br />D~' <br />200909489 <br />Nebraska gepartmerrt of <br />~EWENUE <br />www.revenull.na.gov <br />~ooz/ooz <br />rdH See eF Stele Jphw A 6ele u[C ST4 <br />99098131$5w6 P9s: 1 <br />FULTDN CORY L <br />Filed: 12/01/20W9 08:27 iiM <br />NOTICE OF STATE TAX LIEN <br />P ASE DO NOT RITE N THIS SPACE <br />This Notice of State Tax Lien is issued by the Nebraska Department of <br />Revenue fvr 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 for real and personal property belonging to the taxpayer <br />or-hereafter-ac wired:...,,.:.-......_.=_,..,,.~,.,,~~.,~.,_.--:,, ~,_-,..~_.._r~.,,.:- :.:.... . :....... _.._,...... <br />_ _... <br />e a dent on umber a era entiflcation um r <br />36649309 <br />en Serial Number en F ed Wi 5ocaal ecurity Number Spouse s Saraal Security umber <br />10933016 ®RegisterofDeeds ~CounryClerk XXX~XX-0481 <br />Date a ien en ype County <br />11/30/2009 ®Original ~Continualfan ~CameGed HALL <br />BUSINESS NAME AND LDCA TIQN ALIDRESS TAXPAYER NAME AND MAILING ADDRESS <br /> CORY L FIJLTON <br /> 609 W KOENIG <br /> GRAND ISLAND NE 68801 <br />ax <br />Category <br />Tax Period <br />Date of <br />Amount of Tax <br />Penalttr <br />Interest <br />Additions <br />Balance of <br />Number Assessment Assessment Due <br />22 2005 04/05/2009 1,722.134 524.21 509.77 2,756.62 <br /> <br /> <br /> <br /> <br /> TOTAL $ 2,756.62 <br />I hereby certify that the Ne ras ka Department of Revenue has wmpGed with the revenue laws of the State of Nebraska m the determmatian of the <br />amount shown to be due. and t he taxoaver has f ailed to oav the amount due after demand. If this Notice of Stale Tax Lien is an extension of an <br />effective lien, it serve to a ntinue th{e prig ' of the state's interest in fhe affected property of the taxpayer. <br />Q- Revenue Senior Agent 11/30/2009 (402)595-2091 <br />Sl9tt Pre rs t qa ure - Ti Date eep ne Number <br />here ~ ~ evenue Supervisor 11/30/2009 <br />Authori~ d Signa re Title Date <br />M84-1874 Rr'Y. 2.2002 5upersede84de4.1474 Rav.1a1995 <br /> <br />