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04/21/2011 THU 14:46 FAX 402 471 4429 UCC SECRETARY OF STATE y-�y Hall <br />r <br />� <br />�01�.03069 <br />�41'�aFyrur„�ke aesa�s�rtrn.a�nnr �e <br />�E''�E�i1�E NOTICE OF STATE TAX LIEN <br />wwr w�. r�v� w.t�t, r. rs. � av <br />PLEASE QO WOT WRITE IN TH1S SPACE <br />This Notice of State Tax Lien is issued by the Neb�aska Department of <br />Revenue for unpaid taues pursuant to the revenue laws of the state of <br />Nebraska. Notice is hereby given that taxes includtng penalties and <br />interest, which are shown below, are due from the taxpayer speclfled <br />below �nd remain unpaid after demand. These taxes constitute a lien <br />in the county for real and per�onal property belonging to the taxpayer <br />or hereafter acauired. <br />10595120 <br />�� j p� QX Register of Daeds �County Clerk XXX-XX- <br />�n Lien Type County <br />04/15/2011 QOriginal [IContinuation �Corrected Hall <br />BUSINESS NAME AND LOCATION ADDRES3 TAXPAYER NAME AND MAILING ADDRESS <br />Charles Nora � <br />t or Other Mailing Address <br />2525 West Orice Roth Road Apt. #1408 <br />sta�e <br />Category <br />Number <br />01 <br />01 <br />01 <br />01 <br />01 <br />Tax Period � Date oi <br />09l30/2009 02/11/2011 <br />10/01/2009 02/11/2011 <br />11 /30/2009 <br />12l01/2009 02/11/2011 <br />12/31 /2009 <br />01/01/2010 02/11/2011 <br />01/31/2010 <br />02/01/2010 02/11/2011 <br />02/28/2010• <br />amount shown to be <br />effective lien, it serv <br />8 � <br />Sig�1 �Prepar <br />here e � <br />and the taxpayer <br />:on6nue the arior <br />Amount of Tax <br />406.50 <br />600.OU <br />300.00 <br />300.00 <br />300.0� <br />Gonzales La. <br />Penatty Interest Additions <br />95.85 30.34 <br />120.00 40.35 <br />60.00 18.29 <br />60.00 17.01 <br />60.00 15.86 <br />TOTAL <br />�Iooz/ooz <br />70737 <br />Balance of <br />Ass�ssment Due <br />532.49 <br />760.35 <br />378.28, <br />377.01 <br />375.86 <br />$ 2,424.00 <br />� rcevenue nas comptieu wttn the revenue Iaws of the 5tate of NebrasKa in the tletermination of the <br />�ailed to pay the amount due after demand. If this Notice of State Tax Lien is an extenston of an <br />the state's interest in the affected propeRy of the taxpayer. � <br />� Revenue Agent �/ f� ?p� 402 471-6067 <br />, Title Date Te ephone Number <br />EQ��. Senior Revenue Agent �/ �� // <br />Title pate ' <br />4�{84-1974 Rev. 2 Z002 Supersedes 4-494-1974 Rev. 70-1�5 <br />