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01/21/2010 THU 15:17 FAX 402 471 4429 ^CC SECRETARY OF STATE yyy Hall I~Op2/Op5 <br />C~' <br />~oiooo4s5 <br />N[ Sue ai Slam John A 6~1e - UCC 57L <br />Beitaart~ass-s Pg:: ~ <br />NORTON AUTUMN K <br />Ftlvd: 01!21!2010 09:42 AM <br />Nebraska Department 1af <br />REVENUE NOTICE OF STATE TAX LIEN <br />www.revenue.ne.gov <br /> PLEASE DO NOT WRITE IN THIS SPACE <br />This Notice of State Tax Lien is issued by the Nebraska Department of <br />Revenue for unpaid taxes pursuant to the revenue Paws of the state of <br />Nebraska. Notlce 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 uired. <br />Nebraska Identification Number ederal Identtfica ion Num r <br />37952951 <br />Lien Sena Number ten Filed With Social Security Number pousa's 5oclal Security umber <br />11035089 ®Register of Deeds County Clerk XXX-XX-5647 <br />Date of Lien Lien Type County <br />01/2D/2010 ®Original Continuation ~Carrected MALL <br />BUSINESS NAME AND LOCATION ADDRESS TAXPAYER NAME AND MAILING ADDRESS <br /> AUTUMN H NORTON <br /> 30135 DOGWOOD RD <br /> TREYNOR IA 51575 <br />ax <br />Category <br />Number Tax Period Date of <br />Assessment Amount of Tax Penalty Interest Additions Balance of <br />Assessment Duo <br />22 2005 08/10/2008 877.92 43.9D 224.48 1,146.30 <br /> <br /> Please return Copy to. <br /> <br /> Nebraska Dept of Revenue <br /> PO Box 94$1$ <br /> Lincoln NE 6$509 <br /> TOTAL $ 1,146.30 <br />I hereby certif y that the Nebraska epaRment of Revenue has complied w ith the revenue laws of the Slate of Nebraska in the dw tPrminatinn of mA <br />amount shown to tx;due, and the ta>~ayer 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 se es to continue the priority of the state's interest in the affected properly of the taxpayer. <br />. Revenue Agent 01/2D/2010 (402)471-5928 <br />sign reparer's Signature Title Date elephone Num er <br />here ^ Revenue Su ervisar ovzo/2D1o <br />A prized Signature Title Date <br />4194-1874 Rev. 2-2tlo2 Supersedes 4.494.1974 Rav, fa199g <br />~ I <br />I <br />