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09/14/2010 TUB 14:33 FAX 402 4T1 4429 UCC SBCRBTAItY OF STATB yyy Hdll <br />2oiooss23 <br />~ooz/ooz <br />NE Sea of Stake Jann r uo.. ~ - <br />9g10637ZiZ-6 Pgs. t <br />WINFREY NICHOLAS J <br />Fit4d: 09/14/2010 09:29 AM <br />?;~grnaka ~pspartrr-snt ad <br />I~E`VE~111t.~E NOTICE OF STATE TAX LIEN <br />www.•. rvr•.ti .~~..•~-.Y~ v <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 acquired. <br />9978184 20-8715670 <br />Lien Serial Number Lien Filed With Social Security Number Spouse's Social Security Number <br />/ /~ ~,~ ~ ©Register of Deeds County Clerk xxx-xx-7477 <br />ate of Lien Lien Type County <br />OS/2fil2010 ©Original Continuation Corrected Mall <br />BUSINESS NAME AND LOCATIQN ADDRESS TAXPAYER NAME AND MAILING ADDRESS <br />Business ame Name <br />Nicholas J Winfrey <br />Street Address Street or C+ther Mai ing A ress <br />808 W North Front St <br />ity a Zip Code City State Zip Code <br />Grand Island NE 68801 <br />Tax <br />Category Tax Period Date of Amount of Tax Penalty Interest Additions Balance of <br />Number Assessment Assessment Duo <br />01 ~rlrur Inru <br />12/31 /2007 07/07/2008 0.00 0.00 116.28 116.28 <br />01 1/1/08 thru 08/05/2008 0.00 0.00 103.14 103 <br />14 <br /> 06/30/2008 . <br /> 7/1/08 thru <br />01 <br />09/30/2008 02/10/2009 0.00 0.00 77.96 77.96 <br />01 1/1/09 thru 06/04/2009 0 <br />00 0.00 4.fi4 4 <br />fi4 <br /> 03/31/2009 . . <br /> 7/1/09 thru <br />01 <br />09/30/2009 12/07/2009 0.00 0.00 0.57 0.57 <br /> TOTAi. $ 302.59 <br />I hereby certify that the Nebraska Department of Revenue has complied with the revenue laws of the State of Nebraska in the detemtination 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 Tax Lisn is an extension of an <br />effective lien, it serves to continue the privrit of the state's interest in the affected property of the taxpayer. <br />402 471-5727 <br />- ecr. Revenue Senior Agent 08/26/2010 <br />S19r1 reparer's ' Mature Title Date Telep one Number <br />here ® Revenue Se_nio_r Agent _ ~ ~,~~Z010 <br />Authorized Signature Title Date <br />494-1974 Rev. 2-2tl02 Supersedes 4-494-1974 Rav. 10.1995 <br />