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Tax <br />Category <br />Tax Period <br />Date of <br />Amount of Tax <br />Penalty <br />Interest <br />Additions <br />Balance of <br />Number <br />Assessment <br />Assessment Due <br />01/25/2013 FRI 14:30 FAX 402 471 4429 UCC SECRETARY OF STATE <br />Lien Serial Number <br />nap -64 <br />Date of Lien <br />Business Name <br />Street Address <br />City <br />21 <br />21 <br />21 <br />21 <br />8857784 <br />01/13/2013 <br />1111111111111111111111111 <br />BUSINESS NAME AND LOCATION ADDRESS <br />10/ /2011 02/10/2012 <br />12/31/2011 <br />Lien Type <br />201300629 <br />9� t yr #ck� D000ftmbnt of <br />This Notice of State Tax Lien is issued by the Nebraska Department of <br />Revenue for unpaid taxes pursuant to the revenue Taws 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 />REVENUE NOTICE OF STATE TAX LIEN <br />bV VYWr./ bY�lV Ysi., fa r'. Y'bv <br />Lien Filed With <br />Register of Deeds 0County Clerk <br />Original ['Continuation Corrected <br />State Zip Code <br />0.00 <br />Name <br />City <br />Revenue Agent <br />Federal Identification Number <br />0.00 <br />26- 0047293 <br />Street or Other Mailing Address <br />9508 S. HWY 11 <br />WOOD RIVER <br />Hall 0002 /002 <br />NE Sec of Sia•e John A Gale - UGC STL <br />9913707334 -5 P9s: 1 <br />FISCHER CONSTRUCTION, INC. <br />Filed: 01/25/2013 09:25 PM <br />PLEASE DO NOT WRITE IN THIS SPACE <br />Social Security Number <br />County <br />HALL <br />Spouse's Social Security Number <br />TAXPAYER NAME AND MAILING ADDRESS <br />FISCHER CONSTRUCTION, INC. <br />1.59 <br />State <br />NE. <br />Zip Code <br />68883 <br />01/01/2012 05/29/2012 <br />03/31/2012 <br />04/01/2012 <br />06/30/2012 <br />07/01/2012 <br />09/30/2012 <br />12/24/2012 <br />12/24/2012 <br />1,089.46 <br />1,485.96 <br />1,731.87 <br />54.47 <br />297.19 <br />86.59 <br />37.73 <br />32.73 <br />16.32 <br />TOTAL <br />.?� oeo /3 <br />Title ' ate <br />�� — Senior Revenue Agent <br />Title Date <br />4-494-1974 Rev. 2-2002 Supersedes 4- 494.1974 Rev. 10 -1995 <br />1.59 <br />1,181.66 <br />1,815.88 <br />1,834.78 <br />$ 4,833.91 <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 the taxpayer has ailed to pay the amount due after demand. If this Notice of State Tax Lien is an extension of an <br />effective lien, it sere = ontinue the pri• of the state's interest in the affected property of the taxpayer. <br />e / , <br />sign • rep rer's Signature <br />here e the( <br />. thorized Signature <br />402 471 -6067 <br />Telephone Number <br />1-- 9 3-13 <br />