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12/10/20D9 THU 15:13 FAX 402 471 4429 UCC SECRETARY OF STATE .ate Hall <br /> <br />2409U97`~9 <br />Please forward to: <br />Nebraska Department of Revenue <br />X500 Ave I PD Sox 1500 <br />Scottsbluff, NE 69363-1500 <br />Ha Soo of f!e!~ Jehn W Gals - I1cC 5TL <br />9909613954-7 Pgs: 1 <br />GRRLICK DANIRL J <br />F1led: 12/10/2009 02:18 PM <br />I~003/003 <br />Nebraska..Department of <br />_..-- - <br />REVENUE NOTICE OF STATE TAX LIEN <br />www.re..enue.ne.gov <br /> L E NO WRITE 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 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. <br />Nebraska Identi lion Number Federal nd capon umber <br />38500232 <br />Gen 'al Num r Lien Fil it Social Security Number Spouse's anal Security um <br />10933469 ®Register of Deeds ~ County Clerk XXX-XX-2213 <br />Date 'en Lien Type County <br />12/08/2009 ®Original. ContinuationCorrected MALL <br />t3USINE53 NAME IWD LOCATION ADDRESS TAXPAYER NAME AND MAILING ADDRESS <br /> DANIAL J GARLICK <br /> 105 MULBERRY F'O BOX 308 <br /> ALDA NE 68810 <br />Tax <br />Category Tax Period Date of Amount of Tex Penalty Interest Additions Balance of <br />Number Assessment Assessment Due <br />22 2005 12/11!2008 270.00 67.50 67.45 404.95 <br /> <br /> <br /> <br /> <br /> ToTAI. $ 404.95 <br />I here Certi tltat Netxas ka Department of Revenue has comdied w ith the revenue law s of the State of Ne6ra. a in Nie rt atnrminaHnn nt rl,a <br />amount shown to be d and the taxpa failed to pair the anxx:nt due after demand. If this Notion of State Tax Lien is an extension of an <br />effective lien, it continue e p ' ty of estate's interest in the affected property of the taxpayer. <br />Revenue Agent 12!08/2009 (308)632-1206 <br />Slgrl s i natu Title ate eephone umber <br />here ^ Revenue Su rvisor 12!08/2009 <br />Au orized Sign re Title pate <br />4494.1974 Rev. x2092 Supersedes 4-494.1974 Rev.1D_1995 <br />I <br />i <br />