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Tax <br />vv''" ' lrlie IN 001534 <br />C ategory <br />Number <br />Tax Period <br />Date of <br />Assessment <br />Amount of Tax <br />Penalty <br />Interest <br />Additions <br />Balance of <br />Assessment Due <br />_ . <br />10/01 /2009 <br />12/14/2012 FRI 15:26 FAX 402 471 4429 UCC SECRETARY OF STATE <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 real and personal property belonging to the taxpayer <br />or hereafter acquired. <br />Nebraska Identification Number <br />9812989 <br />Lien Serial Number <br />1"07° ? d vZ-3 <br />Dafe of Lien <br />Business Name <br />Street Address <br />City <br />21 <br />21 <br />21 <br />21 <br />sign <br />here e <br />12/10/2012 <br />BUSINESS NAME AND LOCATION ADDRESS <br />12/31/2009 02/26/2010 <br />rep er's Sign -cure <br />'Aut or <br />z <br />i •% _ • <br />lgnature . <br />Lien Filed With <br />JRe of Deeds OCounty Clerk <br />Lien Type <br />Original OContinuation Corrected <br />State Zip Code <br />0.00 <br />Name <br />Revenue Agent <br />Title <br />263.37 <br />■■•y <br />2012106'74 <br />Hall <br />ti rbra,•sk. D .. rtr sort O/ <br />REVENUE NOTICE OF STATE TAX LIEN <br />wwwv . nue.ne.i,e.. <br />Federal Identification Number <br />20- 4973399 <br />PLEASE DO NOT WRITE IN THIS SPACE <br />Social Security Number <br />County <br />Hall <br />TAXPAYER NAME AND MAILING ADDRESS <br />TRIPLE C TRANSPORT LLC <br />Street or Other Mailing Address <br />201 N. FIRST ST. <br />City <br />12.27 <br />1.2' /'//. 20 / a. <br />Date <br />NE See of SFake John A Gale - UCC <br />11 111 111 I 1111 <br />9912704628 -3 Pgs: <br />TRIPLE C TRANSPORT LLC <br />Filed: 12/14/2012 10;32 AM <br />Spouse's Social Security Number <br />State <br />100.00 <br />Zip Code <br />07/01/2010 <br />09/30/2010 <br />10/01/2010 <br />12/31/2010 <br />01/01/2011 <br />03/31/2011 <br />04/01/2011 <br />06/30/2011 <br />10/28/2010 <br />09/05/2011 <br />08/10/2011 <br />08/10/2011 <br />0.00 <br />9,100.00 <br />5,250.98 <br />2,734.32 <br />0.00 <br />3,185.00 <br />787.65 <br />136.72 <br />10.82 <br />846.68 <br />424.43 <br />186.53 <br />100.00 <br />TOTAL <br />375.64 <br />10.82 <br />13,231.68 <br />6,463.06 <br />3,057.57 <br />$ 23,138.77 <br />I hereby certify that the Nebraska Department of Revenue has complied with the revenue laws of the State of Nebraska in the determination of the <br />,amount shown to be due, and he taxpayer has failed to pay the amount due after demand. If this Notice of State Tax Lien is an extension of an <br />effective lien, it sere- = o • ntinue the priori • • the state's interest in the affected property of the taxpayer. <br />402 471 -6067 <br />Telephone Number <br />12006/009 <br />ST I <br />1 <br />Senior Revenue Agent <br />Title Date <br />4-494-1974 Rev. 2 -2002 Supersedes 4494 -1974 Rev. 10.1995 <br />