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09/16/2010 THU 12:4fi FAX 402 471 4429 UCC SECRBTPaRX OF STAT13 -~~~ Hall <br />2oioosss2 <br />I~Iooz/aaz <br />111111 llllliliinuil ili ~ ~: ,::,,~..: ~« sr~. <br />WIRTT BRf?NpA j -• p~s .~~ <br />~llad: 09/ifi/2010 09,24 ~ <br />Nebraska Department of <br />REVENUE NOTICE OF STATE TAX LIEN <br />www.revenuo.ne.gorr <br />------ <br />PLEASE DO NO WR TE I ACE <br />This Notice of State Tax Lien (s 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 const(tute a lien <br />(n the county for real and personal property belonging to the taxpayer <br />or hereafter ac wired. <br />Nelxaska Identification umber F era anti cation umber <br />98298399 <br />L n erial Number Lien Frled With Social Security Number Spouse's Social Security Number <br />11044546 ®Register of Deeds County Clerk XXX-KX-1880 <br />Date of Lien Lien Type County <br />09/13/2010 ®Onginal []Continuation Corrected HALL <br />BUSINESS NAME AND LOCA TION ADDRESS TAXPAYER NAME AND MAILING ADDRESS <br /> BRENDA J WIRTZ <br /> 217E 9TM <br /> GRAND ISLAND NE 68801 <br />ax <br />Catsgary Tax Period Date of Amount at Tax Penalty Interest Additions Balance of <br />Number Assessment Assessment Due <br /> <br />22 200E 03/D9/2010 580.00 29.00 40.92 649,92 <br /> TOTAL $ 649.92 <br />I hereby ceRif y that t e Nebras ka artment of Revenue has complied w ith the n!venue laws ihp S1atn of NohraR a in 1 ~ AA larn,in9hnn n tie <br />amount shown to be due, and the talq~ayer 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 serves continue the priority of the state's interest in the affected property of the taxpayer. <br />~,.~ ~ Revenue Senior Agent zp (308)fi32-1205 <br />Sl~fl re rsSi Title Dale Teephon Num <br />here ^ ~ Revenue Supervisor J <br />Authorize Signature Title ~~ ~ ~~ ~' t <br />MIBI-1B7~ Rev. ~-2002 Supersedes HBO-191 Rev. 10.1885 <br /> <br />