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11/22/2010 MON 15:39 FAX 402 471 4429 UCC SBCRETARY OF STATE ~~~ Hdll <br />� <br />� <br />201008751 <br />fiiill�rM+tikr ' <br />��� �� <br />ww h�lr.�� r�Y� n.or. n r. q rtr'y <br />�OD7/007 <br />NE Sec sI fl�i• John n 6�Ia - UCC 5T4 <br />9930643670-4 P�s: 1 <br />OERR SHFlWN <br />Filed: 11/22/2010 10:40 pM <br />NOTICE �F STATE TAX LIEN <br />This Notice of State Tax L.ien 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 inciuding penaities and <br />interest, which are shown below, are due from the taxpayer specified <br />below and remain unpaid after demand. Thase taxes constitute a Ilen <br />in the county for real and personal property belonging to the taxpayer <br />or hereafter acqulred. � <br />1062�554 <br />/0 <br />�� <br />�Registar of peeds �County <br />11/13/2010 I nX Original � Continuation <br />�USINESS NAME AND LOCATION ADDRE58�'����� <br />�m�gdry 'Cax Period <br />Number <br />a � �9/21/2Q09 <br />02/28/2010 <br />2 � 10/Q1/2009 <br />03/31/201 p <br />Date of <br />Assessmen! <br />09/27/2Q10 <br />09/27l2010 <br />80-0483877 <br />►:•:�:e:�:e� <br />�Correeted HALL <br />TAXPAYER NAMH"�"_� ,,.— <br />ANQ MAILING ADI�R�SS <br />SHAWN DERR <br />S raet o� r Qther Mailinp Address <br />. � � � ;�'�r' 722 E. 7TH ST. <br />Zip Code Clty <br />GRAND ISLAND <br />Amount ot 7ax Penalty Interest <br />2,Q07.50 <br />390.p0 <br />40$.25 82.70 <br />83.75 13.38 <br />NE. fi8 - <br />� �. <br />Additions Balance of � <br />Assoasment Due <br />z, 498.�5 <br />�487.13 . <br />70TAL �$ 2,985.5$ <br />•�•����T w�•��r •��a. ,��� �.o.,�p��a �npp,uncm u, rcevenue nas compnea with tne revenue laws of the 5tate oF Ne6raska 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 Notics of Slate Tax Lian is an extensian of an <br />ef�ective lien, it serv continue the priori oF the state's interest in the affacted property of the taxpayer. <br />e �4 ' Revenue A ent // /,?v/� ,4D2 471-6067 <br />s�9 n repar r's S�gnature Title .;.� Date elephone Numbar <br />h�re 8 Senior R��ienue A ent //-- p�p <br />t rized Signature Title Date <br />4-494-7974 Rev_2-2pp2 Supa�srdes A-494•7974 Rev.10-1995 <br />