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11/22/2010 MON 15:38 FAx 402 471 4429 UCC SBCRETARY OF STATE ��� Ha�l <br />� ` <br />201008749 <br />�IpD5/Op7 <br />NE S�F af Sk.�r Jdhn p Ba1p - 11CC STL <br />u�n� uw.."' ....." '" "_.__ ._ <br />��.r,v�sooa—a pgs: 1 <br />FTRGERqLp SEpN p <br />Flled: 11/22/2010 10:40 pM <br />=�i�bra�kr �Ssps'IrrMarA o� <br />RE'I�E;�L�E NOTICE QF STATE TAX LIEN <br />www...�,.�. n.u�.. ,..w. a� v <br />PLEAS� DO NOT WRITE 1 HIS SPAGE <br />This Natice of State Tax Lien is issued by the Nebraska Department of <br />Revenue for unpaid taxes pursuant to the revenue laws af the state of <br />Nebraska. Notice is here6y glven that taxes Including penalties and <br />in#arest, which are shown below, are due from the taxpayer specified <br />below and remain unpaid after demand. Thes� t�xes cvnstltute a Ifen <br />in the county for real and personal properly belonging to the taxpayer <br />or hereafter acauired. I <br />102028'!1 <br />`0 � � �,� s �Reeister of Deeds �County <br />Lien 7ype <br />11/1$/2010 [�X Original �Continuation <br />BU5INESS NAME AND LOCATION ADDRESS <br />eusiness <br />Category Tax Period Date of <br />Number Assessment <br />0 � 4/1/p9 thru �9/03/2009 <br />pB/30/2009 <br />� 7/1/109 thru 02/05/2010 <br />09/30/2009 <br />�� 10/1/p9 thru 11/08/2p10 <br />06/30/2010 <br />Amount of 7ax <br />� �� <br />� �� <br />- � �� <br />XXX-XX-6126 <br />�Corrected H211 <br />TAXPAYER NAME ANq MAILING ADDRESS <br />Sean P Fitzgerald <br />! ar Other Mailing Address <br />116 S Monroe St <br />Grand Island <br />Penalty Interast <br />0.00 0.04 <br />24.51 Q.21 <br />122.00 12.25 <br />TOTAL <br />NE 6$801 <br />Additions BalanCe of <br />Assessment Due <br />0.04 <br />24.72 <br />604.25 <br />$ 625.01 <br />�����pMy ������r � ���� �•�� �rpa�u„Cn� o� Revenue nas compnea �nnm ine revenue laws vt the 5late ot Nebraska in the determination of the <br />amount shown ta be due, and the taxpayer has failed to pay the amount due aftar demand. If this Notice of State Tax Lian is an e�ctension of an <br />effective lien, il serves to cankinue the priority of ths state's interest in the affected property of the taxpayer. <br />e � ee� Revenue SeniorA ent 11/18/2010 �02 a71-5727 <br />sign reparers ' ure Title Date Telephone Number <br />hBr� e Revenue Seniar A ent 11/18/2010 <br />Authoriz�d Signature Tltle Date <br />-0�484-1874 Rev. 2-2002 SuparaedeW 4�94-1874 Rsv.10�1995 <br />i <br />