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� 03/14/2011 MON 15:04 FAX 402 471 4429 UCC SECRETARy OF STAT$ ��� Hall <br />' 1 18/2005 1T:21 FAX 14024714429 N6BRASHA UCC � 003/003 <br />' � . we s.� .t si.�. �.n� � a.�. - ucc �R '1 , <br />� � ! <br />� 201102037 � <br />, { <br />. <br />. �- <br />. <br />__...._...._ .........................._.._........_........_....._............ ... . ea�42�s�4— v�: � • � <br />�FRVticES _ ...... . .. .......2.p-p-5-1-2-3 �-2__. _. .__._._ ... _o��_��r_�. _ . _ � ... ... <br />7'pXPAY�R ..._. �, ��. .",e,� .,a..� �, -- .............. <br />p�� 2 2 '1005 <br />N �REGEIVED E . <br />.. <br />� � <br />� . . <br />NOTICE OF STATE TAX LIEN <br />� Thls Notice of State Tax �.ien is issued loy the Nebraska Department af ' <br />, Revenue foc unQaid taxes oursuant to�the revenue taws o( the state af <br />Nebraska. NotH:e is hereby given that #axes�(ncluding penal�os aod <br />interest, which are shown below, are due from the taxpayer speci8ed <br />bebw and remain unpald after demand. Thesa taxes constitute a Iten <br />• in the eounty fflr i+eal aad persona! prr�peciy baloagine W the taxpayar <br />, or hereafter ac utred. • <br />NeMaska IdeMihcadon Number Fodeial ldeMlficalan Num6er <br />' 11610905 ; ' <br />Wmtier • " Uen F�ed With <br />50 4 9 Q02 i. �(] Regbta d Deeds [] C <br />. ' • ' Lkli Typo . <br />12116120Q5 []X �igfie� ❑ContinusUon <br />BUSINESS NAME AN D LOCATION �ADDRESS <br />�me • I <br />:sa ; <br />State Zip Coda <br />Ta�cPeriod DaEeo( I Amout�toiTaz <br />22 I �� I 12/Q112004I� 4,402.00 <br />� �.t✓��� <br />Gerx ---- xYx -xx -3010 , � x -,r.� -$592 '' <br />�:cuoty• : • . . . . • .. <br />[]corieaee ' HAII::'.' ' � • ,. � , .. .. <br />tAXPAYEIt NAklfl AND AiW LINO AD�RESS <br />JERRY L. � CAROLE L. DENTON <br />1 or �thet Maiifmg Address <br />s <br />265 S CEDAR ' <br />' Stale Zip Code <br />GRAND ISLAND NE 68801 <br />Pa�ally kusreet Addidons ._ Balanca of..� <br />220.10 I 442.12 <br />5,064.22 <br />' , , ' .TOTAL jS 5��.� <br />r 1 heteby ceAlfY �hat tho Ne6reska DapaAment of Revdnue has eompNed wilb'ihe revenue faws of ffie State of Ne6raska in tha � <br />detemrination M the atnoiatt showh tc be due, and Iha t�ayer has fa�ed lo pay the amount due aQw demaqd. H Ihis NoG�e of Slate <br />Tax usn Is ex4ensa oi a elJapdve Il�en, il se�ves to continus Uu prWrity ot lho atale's intere�t in lha affee(ed prope�iy of the ta�ayer. ' <br />q n <br />. ( �� Revenue P�qent �a - / - . _ , , 3U8 535-8294 <br />5tgfl � Pre Slgnalu Ttde Dete TelephanaNumhet <br />here � Revenue Se�ior Agent �� �� � <br />A ;�,� rnb oaie <br />� ht94-tB7� Rw. s�ODI fit4ra�du H�•t8M Rw. t0.t8o5 ! <br />! <br />� <br />� <br />�003/OOi <br />� J � <br />V �� <br />G�"� � <br />� `G�, . <br />, <br />,: <br />_. ..._..... ........... .. . ...... . .... .. .. _ __. <br />� <br />Please Retum (figinal Copy to the <br />Nebtaska Dept, of ILevenue at 200 <br />Sont}► Silber, North Ptatte, NE <br />69101 • , <br />