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201002048
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Last modified
3/30/2010 2:53:47 PM
Creation date
3/30/2010 2:49:49 PM
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DEEDS
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201002048
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03/29/2010 MON 14:58 FAX 402 471 4429 UCC SECRETARY OF STATE ~~~ Hall [~J002/002 <br /> <br />2 010 0 2 0 4 8 nnliinuiiliiiliiniiilililuiluui~iiimni <br />Please forward ta: IIIIIIIIIII~IIIIIIIIIIII{IIIIIIII{IIIIIIIIIIIIIII~ <br />Nebraska Department of Revenue <br />4504 Ave I PO Bax 1 S00 99101323194-0 P9g: ~ <br />Filed: 09/29/2010 09:19 API <br />Scottsbluff, NE 69363-1SQU BREDVICK JON J <br />Nebraska Department of <br />REVENI~E NOTICE OF STATE TAX LIEN <br />www.revenue.ne_Gov <br /> PLEASE DO 0 RI E IN TH 5 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 Peal and personal property belonging to the taxpayer <br />ar hereafter ac wired. <br />Nebraska Identification Number Federal Identification Number <br />36994863 <br />Lien Serial Number Lien Filed ith Social Security Number Spouse's Social ecunty Number <br />11 D37828 ®Register of Deeds ~Caunty Clerk XXX-XX-0925 <br />Date of Lien Lien ype County <br />03/25/2010 ®Original Continuation ~Canected HALL <br />BUSINE55-NAME=AND LOCA TION ADDRESS TAXPAYER NAME AND MAILING ADDRESS <br /> JON J SR~DVICK <br /> 2445 LAMAR AVE <br /> GRAND ISLAND NE 6$$03 <br />Tax <br />Category lax Period Date of Amount of Tax Penalty Interest Additions Balance of <br />Number Assessment Ass®ssment Due <br />22 2006 03/04/2009 460.00 23.00 91.40 574.40 <br /> <br /> <br /> <br /> <br /> TOTAL $ 574.40 <br />I hereby certif y that the Nebras ka Department of Revenue has cnmeueri tu irh the 1PVPni ~P law n nr the ctatp ~r Nehracka to eho ~te mr.r,rnfln,,...,r t-,d <br />amount shaven lp be 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 sere o continue the 'ty of the state's interest in the affected properly of the taxpayer. <br />Revenue Agent 03/25/2010 (308)632-1206 <br />sign Pr s t na the ate Teephone umber <br />here ^ ~ Revenue Su ervisor 03/25/2010 <br />prized Si re Title Date <br />«941874 Rav. 2-2002 Supersedes /~94-1974 Rev.1o-1995 <br /> <br />
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