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12/02/2010 THU 14:57 �Ax 402 471 4429 UCC SECRBTARY OF STATB �y� Hd11 <br />�, <br />� <br />zoiousoo2 <br />�Op2/003 <br />N[ i�e af ii�1• Jphn p��t � p[C ETL <br />9910644343�2 Par; 1 <br />ADRMS RICHARD <br />Filed: 12/02/2010 11:02 AM <br />''•tii�sbrpske �CIlm�rrfnvbitil�. abR <br />RE''�E��I,�E NOTICE OF STATE TAX LIEN <br />� <br />PLEASE D T WRITE I THIS SPAC� <br />This Notfce of State Tax Lien is issued by the Neqraska Department of <br />Revenue for unpaid taxes pursuant to the revenue laws of the state af <br />Nebraska. Nat(ce 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.l'hese taxes constitute a lien <br />in the cpunty for real and personal property belonging to the taxpayer <br />o� hereafter acquired. <br />1q56996Q <br />I��S���G <br />�Register af Deeds �County <br />10/16/201Q �Original �Continuation <br />BUSINESS Nq�ME ANp LOCA71pN ADDR�5S <br />Category Tax Pertod bata vf <br />Number Assessment <br />01 01 /01 /2009 10/16/2010 <br />12/31/2009 <br />�� 07/01/2009 � 0/16/2010 <br />09/30/2Q09 <br />Amount of Tax <br />300.Op <br />10p.00 <br />XXX-XX-8216 <br />�Corrected H811 <br />TAXPAYER NAME AND MAILtNG ADDRESS <br />Richard Adams <br />t or pther ailing Address <br />724 W. Louise St. <br />State <br />Grand Island Ne. <br />Penalty Interest Additions <br />60.00 10.85 <br />25.00 4.79 <br />68801 <br />Balance of <br />Assessment Due <br />370.85 <br />129.79 <br />7QTAL � $ 500.64 <br />---_.__, __...., _.._, ,.,_ ..,,�.,,,,..,, „��a,,,,,p„� ,,, „�„���utl �,as �,r�p„ep w�m tne revenue iaws ot tne state of Nebraska in the determination of thB <br />amount shown to be due, and the taxpayer has failed to pay the amount due after demand. If this Notice af State 7ax Lien is an extension of an <br />effective lien, it se continue the pri ty of the stata's interest in the affected properly of tha taxpayer. <br />w <br />e Revenue A ent // 3 ��, f� 402 471 �D67 <br />sign Prepa s Signature Title Da e Telephone Number <br />here e Senior Reven_ _ue Agent_ __ � 1� -. / �/ b <br />thorized Signature �Title � Date •�.. .` <br />4-q9q•1974 Rsv. 2-20p2 Supers6des A�9A-1974 Rw.10-1985 <br />� <br />� <br />