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03/05/20].0 FRT 15:08 FAX 402 471 4429 ^CC SECRETARY OF SxATE ~yy Hall <br />o~ <br />~Oi001485 <br />X003/003 <br />N[ Sep wf 5koke John p 6ele:. uCC STL <br />991013Z1B0B-7 pgs, 1 <br />DIVERS RICHARD D <br />Filed: 03/06!2010 09;04 AM <br />Nebraska Department of <br />REVENUE NUTICE OF STATE TAX LIEN <br />www.revenue_ne.gov <br /> PLEASE DO NOT WRITE IN HI5 SPACE <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 aired. <br />Nebraska identification Number Federal IdenGficahon umber <br />98179241 <br />Lien Serial Number lien Fi ed With Social Seeurily Number Spouse's Social Security Number <br />11036774 ®Register of Deeds ~Counry Clerk XXX-XX-8683 <br />Date of Lien ien Type County <br />03/03/2010 ®original ~Conlinuation [Corrected HALL <br />BUSINESS NAME AND LOCAT ION ADDRESS TAXPAYER NAME AND MAI<aNG ADDRESS <br /> RICHARD v D~vERs <br /> 1601 ALTON ST APT 3 <br /> AURORA CO 80010 <br />Tax <br />Category <br />Number Tax Period Date of <br />Assessment Amount of Tax Penalty Interest Additions Balance of <br />Assessment Due <br />22 2007 05/19/2009 273.00 13.85 31.52 318.17 <br /> <br /> <br /> <br /> TOTAL $ 318.17 <br />i hereby certif y that the Nebras ka Department of Revenue has complied w ith the ravanun iawr nr rho Srarp nr Nohrap4a ~„ 4r,o ri mc,,,,~n~hnn ..r sae <br />amount shown to be due, and the taxpayer has failed to pay the amount due after demand. If this Notice of Slate Tax Lien is an extension of an <br />effective lien, it serves to continue the priority of the state's interest in the affected property of the taxpayer. <br />avenue Agent D3/03/2010 (402)RI71-5928 <br />Slgtl re ignature ~~~~_ .Title ate clap one umber <br />hers / Revenue Su cruiser 03/031z01D <br />Au prized Signatur Title Date <br />4-191.1974 Rav. 2.20D4 Supersedes 4.494.1974 Rev. ta1995 <br />~~ <br />