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07/21/2010 4TSq 14:54 FAX 402 471 4429 UCC SECRETARY pF STATS ~~~ Ha11 <br />u~ 2oioo5os~ <br />.. ~ - 'Nebraska Notice of State Tax Lien <br />_ ~~- <br />~~~~~ <br />Lien vial mbar Lien Type <br />~ ~ 1p ~ Original <br />J Renewal Data <br />~_~4~~~ Social Security Number (~~~~~~ ~~~~~ I~~~~ ~~~) f'III' ~~I'I'III II'r" JIII I"I <br />9510632695-3 Pss: t <br />WHITE FpRM5 TRUCKING iNC <br />F <br />Ne rask LO. No, County <br /> <br />6984 Ha11 LienFiiledtKth <br /> <br />Register of Deeds <br />County Clerk <br />Spouses' Social 5ecudly Number iled: 07/x1/2010 11:17 taM <br />BUSINESS NAME AND LOCATION ADDRESS TA / <br />( <br />XPAYER NAME AND MAILING ADDRESS <br />........................ ~~ame <br />W e Farm i n c <br />Street Address Street or Other Mailing Address <br />City State Zip Code Clty State Zip Code <br />Doni hen NE 68832 <br />-1-0 <br />This Natice of State Tax Lten is issued by the Nebraska Department of Motor Vehicles tow unpaid taxes pursuant <br />to the Iaws of the state of Nebraska. Natice is hereby given that texas induding penalties and interest, which t#rs <br />shown below, are due Pram the taxpayer specified above_.and remain unpaid after demand. These taxes constitute <br />a Iien in the county for real and personal nrenerty helenelnn t!, rh. +A,r.,~,~....,. t,oroaRo~ ~,-n~~treel <br />Tax Period Date of <br />Assessment Amount of Tax Penalty Interest Additions Balance of <br /> Assessment Due <br />sign _1 _ <br />he re ~ 'g S~ tura Hera <br />7 Q?D~ <br />Authorized Signature Ti Date <br />F R COUNTY OFFICIAL'S USE <br />Nebraska Department of Motor Vehicles <br />Motor Carrier Services <br />P 0 Box 94729 <br />Lincoln, NE 68509-4729 DMY Account # 863 <br />NEBRASKA DEPARTMENT OF MOTOR VEHICLES -White and Goldenrod Copies <br />Printed with Soy Ink <br />TAXPAYER -Pink Copy COUNTY OFFICE -Canary Copy <br />HMV -11823969 <br />~~ i <br />i <br />I hereby certify that the Nebraska Department of Motor Vehides has trompUed with the revenue laws of the State of Nebraska in the <br />determination of the amount ahawn Eo be due, and the taxpayer has failed to pay the amount due after demand. If this Nolice of State Tax <br />Lien is an extension of an effective lien, it serves to continue the priority of the state's interest in the affected properly of the taxpayer. <br />