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Q7/il/2011 MON 14:58 FAx 402 471 4429 UCC SSCRETARY OF STATE -�-�� 8a11 <br />, � <br />�� <br />20�105�0� <br />8'�irtbr�a�ka Osiaarfrnaer�t os <br />�E�'�"'E�i�E <br />'YiFiPNWP.Y1i?V i65iEli'.1Ef�.��VY <br />�005/005 <br />- ucc sn <br />Pes: 1 <br />�� <br />NOTICE OF STATE TAX LIEN <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 he�eby given that taxes including penalties and <br />interest, which are shown below, are due from the taxpayer specified <br />below and remaln unpaid after demand. These taxes constitute a lien <br />in the county-far real and personal properly belonging to the ta�cpayer <br />or hereafter acauired. <br />9894969 <br />20-5830030 <br />��� � � QRagister of Deeds �County Clerk <br />; of Lfen Lien Type County <br />06/30/2011 �Orlginal �Continuetion �Corrected Hall <br />BUSINESS NAME AND LOCATION ADDRESS TAXPAYER NAME AND MAILING ADDRESS <br />Category <br />Number <br />21 <br />21 <br />21 <br />Tax Pertod � Date of <br />12/31 /2008 12/26/2009 <br />01 /01 /2009 12/26/2009 <br />06/30/2009 <br />07/01 /2009 01 /15/2011 <br />09/30/2009 <br />Amount of Tax <br />149.98 <br />110.00 <br />130.Q0 <br />J S ASIAN GiFTS <br />t or Other Mailing Address <br />303 WESTERN HILL B <br />Stete <br />CHEYENNE WY. <br />Penalty Inte�est Additions <br />37.50 <br />62.50 <br />32.50 <br />16.61 <br />25.99 <br />10.81 <br />82009 <br />Balance of <br />204.09 <br />198.49 <br />173.31 <br />TOTAL � $ 575.89 <br />���0���7 w����7 ���a••��= ••���a�nd �oNa�unCn� vr nevenue nas compuea wi[n me revenue iaws ot tne state ot IveDrasKa in UIe determina�on of the <br />amount shawn to be due, a d the taxpayer has failed to pay the amount due after demand. If this Notice of State'�ax Lien is an extension of an <br />effedive lien, it serv ntinue the priori e state's interest in the afPected property of the taxpayer. <br />e � Revenue Agent �'J" p o 402 471-6067 <br />sign repa r's Signature . Tdle Da Telephone Number <br />here e Senior Revenue A ent �'�—'� // <br />horized Signature T�le Date <br />4�841874 Rev. 2-2002 Slryersedas 4-084-1974 Rev.10•1895 <br />� <br />� <br />, <br />