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11/05/2010 FRI 15:1$ FAX 402 471 Q429 ❑CC SECRBTARX OF STATE �yy Hall <br />� r <br />�002/002 <br />01 i��4� Jehn_11 6�1r � UC[ <br />24100827G <br />..� , <br />�..,,...,.---•�------------ ���, , <br />�4�3�8-8 <br />eY NICHOl.AS .1• <br />: 11106l�010 09:85 RPI <br />Pfabraskw IQecp�nrns►+M1 aA <br />�E�'E�I�E NOTICE OF STATE TAX LIEN <br />ww�rw.e�.v�nrF�. n�►.yov <br />This Notice of 5tate Tax Lien is issued by the Nebraska Department af <br />Revenue for unpaid taxes pur�uant to !he revenue laws of the state of <br />Nebraska. Notice is hereby giv�n that taxes including penalties and <br />intarest, which are shown below� are due from #he taxpayer specified <br />below and rematn unpatd after demand. These taxes constltuke a lien <br />in the county for real and personal property helonging to the taxpayer <br />or hereafter acauired. <br />997$194 <br />�Q g�� �RegisterofDeeds QCounty <br />Lien Type •�� . <br />11/01/2Q10 Qori9inal [�Continuatiari <br />BUSINESS NAME AND LOCATIpN A�DREBS <br />Category Ta�c Period Date of <br />Number Assessment � <br />Q1 1/1/10 thru � 1/Q1/2010 <br />06/30I2010 <br />Z � 1/1/10 thru 11/01/201D <br />06/30/2010 <br />Ampunt of Tax <br />zso.00 <br />150.OQ <br />� <br />6$801 <br />ealance of <br />Assessment Due <br />� �ss.sa <br />2�2.8fi <br />TO7AL I � 566.40 <br />I hereby Certlry that tne Nebraska pepartment of Revenue has compliBd with the revenue laws of the 5tate oi NBnrasKa in the peterrnination of the <br />amount shown to ba due, and the taxpayer has failed la pay the amount due after demand. If this Notir.� of State Tax Lien is an �xtension oF an <br />effactive lien It serves to continue the priariry of the state's interest in the affected praparty of tbB taxpayer. <br />e Revenue Senior Agent 11/ /10 <br />402 471-5727 <br />SI 11 ar Signatur Title "" 17at Talephone Number <br />he e e��� �-� �� Revenue Senior Agent __ 11/ �/1 p <br />Authorized Slgnature Title � �'�' Date <br />4�494-1874 Rav. 2•20U2 Supersadea 4A9M197A Rw. 70-1�95 <br />20-8715670 <br />0 <br />XXX-XX-7477 <br />�Corraded ' Hall <br />TAXPAYER NAM� AND MAILING ADDR�SS <br />Nichotas J. Winfrey <br />or er Mai ing Address <br />808 W Nprth Front 5t <br />Grand Island NE <br />Penalty Interost Addltions <br />7$.00 5.54 <br />5�.D0 2.8fi <br />\� <br />