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03J10/2011 THU 13:59 FAX 402 471 4429 UCC SECRBTARY OF STATE �y� Hall <br />�ooa/oo7 <br />'�/ <br />201 10194G <br />...�_ � <br />'V�wbrasks �aporinvvnl6+ <br />������ �i� i iC�t t3�r ST�T� TAX LiEN <br />www�...v.n,t...... oa.. <br />' PLEASE DO NOT WRITE IN HI SPACE <br />This Notice of State Tax Lien 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 including penalties and <br />interest, which are shown below, are due from the taxpayer specified <br />betow and remain unpaid after demand. These taxes constitute a lien <br />in the county for real and personal property belo�ging to the taxpayer <br />or hereafter acquired. <br />9873562 <br />20-5598553 <br />11152848 QX Reg+ster of Deeds [ICounty Clerk � xxx•xx-7532 <br />Lien Type County <br />03J09/2011 [�X Original �Continuation �Corrected Hall <br />BUSINESS NAME AND LOCATION ADDRESS TAXPAYER NAME AND MAILING <br />Category Tax Period � Date of <br />Number Assessment <br />2 � 10/1/07 thru 10/17/2010 <br />03/31i08 <br />Amount cf Tax <br />2,335_39 <br />Kevin W Bist <br />t or Other Mailing <br />1812 College <br />Grand Island <br />Penatty <br />116.77 <br />St <br />state <br />NE <br />Interest Additions <br />409.95 <br />68803 <br />Balance of <br />�essment Due <br />2,862.11 <br />TOTAL �$ 2,862.11 <br />i nereoy cemry uiat u�e rve�rasKa uepaRmem or rcevenue nas compuea wnn tne revenue taws or me �tace or rveorasKa m[ne aeterminauon or tne <br />amount shown to be due, and the taxp yer has f d to pay the amount due after demand. If this Notice of State Tax Lien is an extension of an <br />effective lie 't�`erves to n r' ity of � e t� '' terest in the afFected propeRy of the taxpayer. <br />8 Revenus Agent 402 471-5788 <br />sign ar ig Title Date Telephone Number <br />h�Pe � RevenueSeniorAgent 3-q // <br />Authorized Signature Title Date '^ <br />4-494-1974 Rev. 2-2002 Supersedas 4�94-1974 Rev. 70-1995 <br />. V }. <br />p <br />