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10/13/2011 T8U 14:36 FAx 402 471 4429 UCC SECRETARY OF STATE y-�y Hall <br />1 <br />� <br />EU.IS <br />Filed: <br />�ooa�ooa <br />1 09: �8 t�f'I <br />�0110765�. <br />� <br />Nebreska Department of <br />I���IEIV.UE NOTICE OF STATE TAX L1EN <br />www.revenue.ne.�vv <br />19163067 �Register ot Dceds �County Clerk XXX <br />Date of Lien Lfen Type Camty <br />10/11/2011 �(]Odgl�al �ConUnuation []Corcected Hq�� <br />This Notice of Stete Tax Lisn Is issued by the Nebraska Department of <br />Revenue for unpaid taxes pursuant to the revenue laws of the state of <br />Nebraska. Nodce is hereby glven that taxes including penalties and <br />irrterest, which are shown below, are due from the taxpayer speclfled <br />below and remain unpatd after demand. These taxes constitute a Ilen <br />in the county for real and personal properly beionging to the �xpayer <br />or hereafter ac uired. <br />Nebraska Identi�catl� Number Federai den ficaHa <br />98242008 � <br />Lien SeR umber' en Filed Wfth Soaat <br />NAME AND LOCi4T10N ADDRESS 7AXPAYBR NAAAE AND BlIAILING ADD(iESS <br />CHARLIE D ELLIS <br />803 E DIVISION ST <br />GRAND ISLAND NE 68801-2216 <br />Cetegory Tax Perlod Data of <br />Numbe� Assessmei <br />22 2008 05/26/20Q8 <br />Amount of Tax <br />313.74 <br />Penalty <br />16.75 <br />Interest Addlticns <br />41.46 <br />Balance af <br />371.85 <br />' I I I I I TOTAL I$ 371.95 I <br />I her�y ceA�fy that the Nebreska Depa�tment of Revenue has complied wiih the revenue lews of the State o} Nebraska in the determination of ihe <br />amount shoxm to be due, end the ta�y� ha iled�to pay the amount due after demend. If this NoHce of State Tax Lien is an e�densinn of an <br />effective lien, it serv stncoritinue t �Rerip o( s' rest in the alfected property of the ta�ayer. <br />� R venue Agent �/ -�� (308j632-1208 <br />sign Prepa Si ture Title Date Telephor� Number <br />here ► Revenue supenrisor /v !� J <br />orized ' na TiUe Date <br />4-484-1874 Rer.2-2071 Supersadas 1-094-19T� Rev.1C-1885 � <br />