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10/24/2011 MON 15:18 FAx 402 471 4429 UCC SBCRETARY OF STATE y-+� 8a11 <br />� <br />11 <br />� V � � V � � � V <br />:....,_-�� <br />� r��� ���� � <br />���'���. <br />`www4m. � rv�. R w.s.:►. yiWr++� <br />�003/003 <br />ot State .lohn p 6ale - UCC STL <br />i75041-1 P9s: 1 <br />N DENNIS <br />: i0124120i1 02:20 Ppl <br />t <br />l <br />NOTICE OF STATE TAX LfEN � <br />t <br />This Notice of State Tax Lien is issued by the Nebraska Department of <br />Revenue for unpald taxes pursuant to the revenue laws of the state of <br />Nebraska. Notice is hereby given that ta�cc�s including ponalties and <br />interest� which are shown below, are due from the taxpayer specified <br />below and remain unpald after demand. These taxes constitute a Ilen <br />in the county for real and pe�onal property befonging to the taxpayer <br />or hereafte� acquired. <br />7009674 <br />/�� 3 � QRegister of Deads �County <br />of Lien Lien Type <br />10/07/2011 QOriglnal �Continuation �]Corrected HALL <br />BUSINESS NAME AND LOCATION ADDRESS TAXPAYER NAME AND MAILING A <br />I DENNIS NELSON <br />t or Other Maii ng Add�ess <br />501 N. PINE ST. <br />s� <br />GRAND ISLAND NE. <br />Penalty tMerest Additions <br />Category <br />Number <br />01 <br />01 <br />01 <br />41 <br />01 <br />Tax Perlod I Date of <br />02/28J2011 04105/2011 <br />03/01 /2011 05/05/2011 <br />03/31/2011 <br />04/01/2Q08 05/04/2011 <br />1 2/31/2 010 <br />04l01 /2011 06/06/2011 <br />04/30/2011 <br />05/01 /2011 07/Q6/2011 <br />05/31/2011 • <br />Amount of Tax <br />o.oa <br />0.00 <br />11,734.12 <br />241.68 <br />0.00 <br />47-0776255 <br />XXX-XX-9068 <br />25.00 a.10 <br />25.00 1.63 <br />1,214.00 1,213.89 <br />25.00 4.47 <br />0.00 0.30 <br />• TOTAL <br />68801 <br />Balance of <br />25,10 <br />26.63 <br />14,162.�1 <br />271.15 <br />0.30 <br />$ 14,485.19 <br />� nereDy cer[iry [na[ uie rveorasica uepaRmen[ or rtevenue nas compuea witn tne revenue �aws ot tne 5tate ot NebrasKa m the tleterminaUOn of the <br />amount shown to be due, and the taxpayer has failed to pay the amount due after demand. If this Notice of State Ta�c Lien is an extension of an <br />eFfedive lien, it serv o• ntinue ihe prio ' th� state's interest in the affected •property of the taxpa'yer: .'• `' � ' ' <br />e ,-- �, � Revenue Agent �, �p 402 471-8067 <br />sign rep e�'s Signature Title Date Telephone Number <br />here 8 ��� 5enior Revenue Agent /(J' v� (�" �� <br />uthor�ed'Signature • 7iUe " ' Date • • <br />•• ' � � � • • � a�a9o-�e�n Rev. z-2ooz su�rsedesa�sa.�s�q Rev. �a�sss <br />, � . � . <br />