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12/09/2011 FRI 14:43 PAX 402 471 4429 UCC SECRSTARY OF STATE ��-� Hall <br />!� . <br />V <br />� '�s'"~--�- � <br />Nebraske DepartmeM of <br />����� NOTICE OF STATE TAX LIEN <br />www.reven'.ue.ne:gov <br />�ooz/oo3 <br />N& Sec af Steie Jcim A Gale - UCC STl <br />201109 <br />9911679019-8 Pgs: 1 <br />HRNN FlDRPi D <br />Filed: 12/09/2011 10:04 Ai'1 <br />PLEASE RETURN T0: <br />NEBRASKA DEPT OF REVENUE <br />1313 FARNAM-ON THE-MALL <br />�MAHA NE 68102-1871 <br />This Notice of State Tax Lien is issued by the Nebraska�Departmer�t of <br />Revenue for unpaid taxes pursuant to the revenue laws of the state of <br />Nebraska. Notice is hereby given that taxes including penaities and <br />interest, which are shown below, are due from the taxpayer specifled <br />below and remain unpaid after demand. These taxes co�satute a Iten <br />tn the county for real and personal property belonging to the taxpayer <br />or hereafter acquired. <br />38476495 <br />11766554 �Register of Deeds �Counry Clerk XXX-XX-1015 <br />Daie oi Lien � Uen Type ���Y <br />12/0712011 �Original �Condnuabon �Corrected HALL <br />BU5INESS NAM� AND LOCATION ADDRESS TAXPAYER NAME ANO MAIUNG ADORESS <br />ADAM D HAHN <br />4215 KAY AVE <br />GRAND ISLAND NE 68803 <br />Cat�gary <br />Number <br />22 <br />iy] <br />TOTAL ' � $ • 3,469.92 <br />I hereby celddfy that the Nebraska Department of Revenue has campfied with the revenue iaws o� u�e oia[e a� neorasAa �n u�e uG�C������tiu��� u� u�� . <br />amount shown to be due, and lhe taxpayer has lailed to pay the amount due afler demand. If this Noti�e o( State Tax Lien is an exlension of an <br />effective Gen, it senres to conGnus l�e prig 'ty of the state's interest in the affected property of the taxpayer. <br />� Revenue Agent � �� — 7 � � (308)632-1203 - <br />. .sign Ptepa e . . , Tide Date . . - elephone b . <br />here ► - "'� �� Revenue Supervisor /� % <br />s <br />Authoued Sig ure Title Date . <br />• ' . . . . . • • . _ - • 49$4-1874 ReY, 2-?G02 Supersedes 4�GB41974 Rev.10-1885 ' <br />7ax Period I Date oi <br />2007 106I21I2011 <br />2008 I 07/19/2011 <br />Amount of Tax Penaity <br />1,013.00 253.25 <br />. 1,412.00 398.47 <br />Ir�terest � Addidons <br />206.35 <br />186.85 <br />a <br />9alance oF <br />1.472.60 <br />1,997.32 <br />r • <br />�. . <br />� <br />i• <br />, <br />j. <br />; <br />I <br />i <br />I <br />i <br />; <br />.� <br />