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09/03/2010 FRI 15:02 FAX 402 471 4429 UCC SECR13TAltY OF STATE ~~~ Hall <br />V~ <br />201006358 <br />X003/004 <br />NE Sae of SiNe Jahn A sofa ~ UCC SYL <br />9910636458-5 pas: t <br />DAViD50N KATHLEEN C. <br />Fllnd: 09/03/4010 11:41 AM <br />7K~sbr~+rkr 9,s~wrun~.e~we by <br />F~E1~E~IItJ!E NOTICE ~F STATE TAX LIEN <br />wvww_e wr~wnnnr. ~~. yov <br />. ._ ..p-----------=--___~. _-:_.EASE:DfJ...~._......._...--_.__ N=T1it~S>~~~:~...:::.:.:..-......_...._..W <br />_.~ .:o It;~a fate-Tax Cienm~:.:~ssuedby the-Ne ........ - --- - ~ ~ ..- <br />brask~a~~De artment 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 acquired. <br />8923027 <br />I Register of Deeds County <br />08/22/2010 I Qt]riginal Continuation <br />BUSINESS NAME AND LOCATTION ADDRES$~ ~~ <br />xxx-xx-ss75 <br />Corrected I Hall <br />TAXPAYER NAME AND (NAILING ADDRESS <br /> Kathleen C. Davidson <br />treat Address Street or ether Mailing Ad ress <br /> 2120 Chanticleer <br />ity a e zip code City <br /> Grand Island <br />Tax <br />Category Tax Period pate of Amount of Tax Penalty Interest <br />Number Assessment <br />01 07/01 /2009 <br />09/30/2009 11 /04/2009 115.18 25.00 4.75 <br />01 01/01/2010 <br />03/31 /2010 05/06/2010 115.18 25,00 1.88 <br />01 04/01/2010 <br />06/30/2010 08/04/2010 115.18 25.00 0.44 <br />140.62 <br />TOTAL I $ 427.61 <br />I Hereby certify that the Nebraska Department or Revenue as 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 lax Lien is an extension of an <br />effective lien, it serv continue the priority estate's interest in the affected property of the taxpay r. <br />e ~ C. - Revenue A ant ~ ,~v v 402 471-6067 <br />sign Pre arers Signature Title Da a Telephone Number <br />here e ~ Senior Revenue A ant ~ ~ /~ <br />Authorized Signs ure Title Date <br />4AB4-1974 Rev. 2-20D2 Supersedes 484-7974 Rev. 10.7895 <br />Ne. 68$01 <br />Addltfons Balance of <br />Assessment Due <br />144.93 <br />142.06 <br />\V <br />V <br />