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il/04/2011 FRI 15:04 FAX 402 471 4429 UCC SECRETARY OF STATE ��� Hall <br />� <br />2U11(�8382 <br />Interest � Additions <br />- �i'1:.�z— <br />Nebraska Qepactment af <br />REI/EN�lE NOTICE OF STATE TAX LIEN <br />wvi;�n,::reve_n u e: � e. g o v <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 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 rea! and personai p�operty betonging to the taxpayer <br />or hereafter ac uired. <br />Nebraska Identlficatia� Nwnber Federal Iden64cation Number <br />98835637 <br />Lien 'al Number Lien Filed With Social Security Number Spouse's Social S <br />11164543 �Register of Deeds �Counly Clerk XXX-XX-7276 <br />Date of Lien Lien Type County <br />11/02/2011 �Original �Continua6on �Corrected HALL <br />BUSINESS NAME AND LOCATION ADDRESS TAXPAYER NAME AND MAILING ADDRESS <br />MAGUEN MARIAL <br />2540 W ST APT 2 <br />LINC�LN NE 68503-7759 <br />Category Tax Period Date of AmouM of Tax Penaity <br />Number Assessment <br />22 2Q07 02/05l2009 285.00 14.25 <br />amount shovvn to be due, and the <br />effective lien, it to con6nue <br />sign ��/�� s�9�r� <br />here ► �!�: � _.,� <br />56.63 <br />f�ooa�ooa <br />355.88 <br />� I I � � TOTAL I$ 355.8s ( <br />x�t of Revenue has complied with the revenue laws of lhe State of Nebraska in the determinaUon of the <br />has failed to pay the amount due after demand. if this Notice of State 7ax Lien is an e�Aension of an <br />ty of the state's interest in the affected property of the taxpayer. <br />� Revenue Agent 1- Z — �+ (402)471-5712 <br />� Title Date Telephone Number <br />���Revenue Supervisor /�, �, /� <br />� Title Date <br />4�94-1971 Rev. 2-2002 Supersedes 4494=1974 Rev.10-1995 <br />�� <br />Balance of <br />MpRi{�. MHGUtn <br />Filed: 11I0A/2011 i0:27 <br />