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10/24/2Q11 MON 15:18 FAX 402 471 4429 UCC SECRETARX Og STATE y-�-+ 8a11 <br />/� <br />�� <br />�0110796�. <br />�looa/oo3 <br />- ucc sn <br />�s: , <br />NEL50N DQJNIS <br />Filed: 10/24/2�11 02:17 PM <br />l�ir�prasi!u• �fp�sir� a� <br />_ _ _ __. ._ _ _ - ��;��� NOTICE OF ST,ATE TAX L1EN <br />� „�, � .. � � , . �, , , . �.. �... , � <br />This Nottce of State Tax Lien is issued by the Nebraska Department of <br />Revenue for unpaid taxes purr,uant to the revenue laws of the state of <br />Nebraska. Notice is hereby given that taxes including penalties and <br />interest, which are shown below, are due from the taxpayer specified <br />below and remain unpaid after demand. These taxes constitute a lien <br />in the county for reai and personal property belonging to the taxpayer <br />or hereafter acauired. <br />7009674 <br />. IIf 6,� y/8� �[]X Rastster of �eeds �County <br />Date of Lien Lien Type <br />10/07/2011 `QOtlginal []Continuation <br />BUSINESS NAME AND LOCATIOId ADDRESS <br />Category � Tax Period � Date of <br />01 06/30120i 1 08/0�4/2011 <br />01 07/01 /2011 09/06/2011 <br />07/31 /2011 <br />Amount of Tax <br />169.40 <br />190.90 <br />47-0776255 <br />XXX-XX-9068 <br />[]Conected I MALL <br />TAXPAYER NAME AND MAILING ADDRESS <br />DENNlS NELSON <br />! or Other Mailing Address <br />501 N. PINE ST. <br />5tate <br />GRAND ISLAND NE. <br />Penalty (nterest Additio� <br />O.QO 1.72 <br />25.00 I 1.12 <br />68801 <br />Balance of <br />:essment C <br />171.12 <br />217.02 <br />TOTAL -I$ 388.14 <br />I hereby certity that the Nebraska Department of Revenue has complied with tne revenue taws ot tne �tate oi NeorasKa �n u�e ae�erm�nanvn or me <br />amount shown to be due, and the taxpayer has failed to pay the amount due after demand. lf this Notice of State Tax Lien is an extension of an <br />effective•f'�en, it se wntinue the prio ' the state's intere�t in the affected property.of the.taxpayer. � . <br />, ` <br />e Revenue Agent /o / ,70// 402 471-60G7 <br />sign Prep rers Si nature ,/ �Title Date Telephone Number <br />here e S�L� Senior Revenue Agent /D��� <br />' Authorized Signatura � • Title • Rate <br />. . . a�sa-ta7a Rav. 2 zuo2 su�sesa�sa-ts7a ttev. �a�sss <br />� <br />i <br />i <br />� <br />�, <br />