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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 />v't <br />Jul. 25. 2013 2:40PM NE Secretary of State — UCC <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 Identifleation Number <br />10586679 <br />Lien Serial Number <br />Date of Lien <br />Business Name <br />Street Address <br />City <br />01 <br />01 <br />01 <br />01 <br />01 <br />01 <br />sign <br />here <br />07/19/2013 <br />Lien Flied With <br />Lien Type <br />BUSINESS NAME AND LOCATION ADDRESS <br />09/01/2012 11115/2012 <br />09/30/2012 <br />Original DContinuatio <br />0.00 <br />Zip Code <br />Aut orized Signature - �' Title <br />2013059 <br />I% .bWMakn *r dfmI.n* O <br />REVENUE NOTICE OF STATE TAX LIEN <br />Register of Deeds []County Clerk <br />Revenue Agent <br />Title <br />Federal Identification Number <br />Name <br />GARY LEMBURG <br />Street or Other Melling Address <br />2805 FT. WORTH AVE. <br />City <br />1 Corrected <br />80- 0439865 <br />Social Security Number <br />XXX -XX -9740 <br />TAXPAYER NAME AND MAILING ADDRESS <br />GRAND ISLAND <br />PLEASE DO NOT WRITE IN THIS SPACE <br />County <br />Hall <br />10/01/2012 <br />10/31/2012 <br />12/01/2012 <br />12/31/2012 <br />11/01/2012 <br />11/30/2012 <br />01/01/2013 <br />01/31/2013 <br />02/01 /2013 <br />02/28/2013 <br />1221/2012 <br />02/01/2013 <br />03/01 /2013 <br />03/01/2013 <br />03/25/2013 <br />0.00 <br />0.00 <br />0.00 <br />769.02 <br />58.75 <br />72.62 <br />0.00 <br />94.37 <br />0.00 <br />7.65 <br />5.55 <br />6.96 <br />10.71 <br />1,194.86 <br />• 11.88 <br />TOTAL <br />56.68 <br />Revenue Senior Agent <br />8.90 <br />I hereby certify that the Nebraska PepaRment 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 failed to pay the amount due after demand. If this Notice of Slate Tax Lien is an extension of an <br />effective lien, ill se p' to continue the prior the stele's Interest in the affected property of the taxpayer <br />No. 0120 P. 3/5 <br />NE Sec of State John q 6.1. - UCC S7L <br />I11 1 1111 10 101 <br />9913719578 -5 Pas: 1 <br />LEM6tic GARY <br />Filed; 97/25/2013 18:28 AM <br />State <br />NE. <br />Spouse's Social Security Number <br />4494 -1974 Rev, 2.2002 Supemedes 4.491.1974 Rev, 104995 <br />Zip Code <br />68803 <br />65.58 <br />66.40 <br />78,17 <br />6.96 <br />874.10 <br />1,206.74 <br />$ 2,297.95 <br />402 471 -6067 <br />Telephone Number <br />7 <br />Date <br />