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12/29/2009 TUE 14:22 FAX 402 471 4429 UCC 58CRETARY pF" STATS ~»~ Hall X002/002 <br />NE Snc of Skak^ JeM R Gala -UCC ST4. <br />Please return to: <br />STATE OF NEBRASKA gg096~s34t3-0 Pgs: 1 <br />DEPARTMENT OF REVENUE boUTHIT XANE R <br />Filed: 12/39/2009 09:12 R11 <br />1811 WEST 2N° ST 5TE 460 ~ O O 1~ 1 ~ 2 i <br />GRAND ISLAND NE 6$803 •7 <br />~.; Q~Yxsrlt ~ <br />~E''~"~~E NOTICE OF STATE TAX LIEN <br />This Notice of State Tax Lien is issued by the Nebraska Department of <br />Revenue for unpaid taxes pursuant to the revenue laws of the state of <br />Nebraska. Notice is hereby given that taxes including penalties and <br />interest, which are shown below, are due from the taxpayer specified <br />below and remain unpaid after demand. These taxes constitute a lien <br />in the county for real and.personai property belonging to the taxpayer <br />or hereafter acquired. <br />10366164 <br />D I ( ~ Register of beds • County Clerk X)()(-XX-8044 . <br />~ of Lien Lien Type County <br />12/28/2009Original Continuation Corrected Hall <br />GUSINESS NAME ANp LOCATIpN ADDRES5 TAXPAYER NAME AND MAILING ADDRESS <br />Hess Name Name <br />4 <br />Category Tax Pertod Date of Amount of Tax <br />Number Assessment <br />p1 12/01/2008- 12/07/2009 14,635.81 <br />1 p/31/2009 <br />Zane R Douthik <br />t or Other Mailing Address <br />1810 Caroline Ave, A <br />Junction City <br />Penalty, Interest <br />912.37 I 363.98 <br />E 303 <br />State <br />KS <br />Additions <br />TOTAL <br />66441 <br />Balance of <br />Assessment Due <br />15,912.16 <br />$. 15,912.16 <br />I hereby certify that the Nebraska Department of Revenue has complied with the revenue laws of the State of Nebraska in the determination of the <br />amount shown to be due, and the taxpayer has failed to pay the amount due after demand. If this Notice of State Tax Lien is an extension of an <br />effective lien, it serves to co tinu a priority of the state's i in the affected ope of the taxpayer. <br />e !~ 308 385-6073 <br />sign Prepay 's i natu i Oate Telephone Number <br />here 6 / <br />Autho ' d ignatur Tie Date <br />4~19a-1974 Rw. 2-20U2 Supersedes 494-174 Rav.10-1995 <br />