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05/12/2011 THU 13:50 FAX 402 471 4429 i1CC SECRETARY OF STATE -�yy Hall <br />�i, <br />1 <br />201103608 <br />f�ooz/ooa <br />��: �. .: <br />t�ebraska: Dapar-E�ci��t .of <br />��;r� ���� NQTICE OF STATE TAX LIEN <br />. .�.. . � <br />Thls Notice of State Tax Llen is issued by the Nebraska Department of <br />Revenue for unpald taxes pursuant to the revenue laws of the state of <br />Nebraska. IVotice is hereby given that taxes including penalties and <br />interest� which are shown be{ow, ane due from the taxpayer specified <br />below and remain unpaid after demand These taxes cons�itute a(ien <br />tn the county for real and personal properly belongfng to the taxpayer <br />or hereafter acauired. <br />97321Q95 <br />11155344 � Regist�r oF Deecis �County Cl�ic XXX-XX-8816 XXX-XX-9323 <br />�ate of Li� Lien Type Camty <br />05/10/2011 �O�iginal �C�tmu�ation �Corre�ed Hq� <br />BUSINESS NAINE AND LOCATION ADDRESS TAXPAYER NAME AND MAILING ADDRES9 <br />MICHAEL M JOHNSON <br />LYNN M POTTER <br />314 CHEROKEE <br />GRAND ISLAND NE 68803 <br />Category Tax Perfod Date of <br />Number Assessment <br />22 2007 06/02/2009 <br />22 2008 05/26/ZQa9 <br />Adwunt of Tax Penalty <br />308.00 17725 <br />640.00 27.00 <br />Interest I Addidons <br />105.04 <br />55.85 <br />TOTAL �$ 1,214.14 <br />Balance of <br />sessment Due <br />591.29 <br />622.85 <br />� <br />i r�esUr cxr wy uw[ u�e rve�ras�m uen'druTlen[ oi KevEt1UE �3s Com�U2tl Wltl't tf1E r8Ve11ue la1M5 01' tl� 5tat9 Of Neh12� Ifl tl1e detemU11�60n Of tlte <br />amount st�m to be due, and the tax�yer has failed ta �y fhe amount dus after demand. If this Notice of Sate Tax Lien is an exte�ian of an <br />effecSve lien, � s�erve� to continue tl� priority of the sYate's intere� in ihe affected ProPedY of the t�cpayer. <br />� u ' RevenueAgent 5•�Q•aQf ) (402)471-5731 <br />sign Pre�r na re Title Dade Telephon umbet <br />here ► Revenue Supervisor � 0 ( <br />Authorized Signatu Title Date <br />4�494d974 Rev. 2•2UO2 Supetsedes 4�4841874 Rea 141886 <br />�� <br />� <br />