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03/08/2001 17:20 FAX 14024714429 NEBRASKA UCC _ Z002/002 <br />NO S.r of St.ly UCC SQL <br />IIl IIII IIIIIIIIillllilllllllllllllllllll <br />9901122740 Pys. <br />TR[ GOLDEN NEBRASKR L L C <br />Filed. 03108/2001 02:23 PM <br />Or <br />neereslle <br />del leTent <br />of revenue <br />200101847 <br />Notice of State Tax Lien <br />PLEASE DO NOT WRITE IN THIS SPACE <br />This Notice of State Tax Ueu is Issued by the'Nebraska Depadment 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 i <br />interest, which are shown below, are due from the taxpayer specified 1 <br />below and remain unpaid after demand. These taxes constitute a lien in <br />the county for real and personal property belonglag to the taxpayer or <br />hereafter scouired. <br />Nebraska Identificetion Number <br />7789068 <br />Lien Rled With <br />® Rai lsterof Deeds ❑ County Clark <br />Social Security or Federal I:D, Number <br />91- 1773485 <br />Spouse's Social Security Number <br />Lien Serial N millow <br />01/03/314 <br />LJen Type <br />® original ❑ Continuation ❑ Corrected <br />I Date of Lien <br />1 03 -06 -01 <br />County <br />;inu <br />BUSINESS NAME AND LOCATION ADDRESS <br />TAXPAYER NAME AND MAILING ADDRESS <br />Buslness Name <br />Name <br />TRI— Gil MMSKA, L.L.C. <br />Street Address <br />Street or Other Mailing Addmes <br />4602 PLE'i'1 qER LANE 4A <br />City Stme Zip Code <br />City State Zip Code <br />E«RGIRM CO 80439 <br />Tatar <br />CaTax ly <br />Number <br />Tax Parlod <br />Ass ft f <br />Amount of Tax <br />Penalty <br />Intarest <br />Addiuorn <br />Balance of <br />Asaeearneril Due <br />21 <br />0 — — — <br />12 -31 -99 <br />02 -11 -00 <br />11 -27 -00 <br />0.00 <br />1 0527.GG <br />622.23 <br />526.39 <br />645.41 <br />A62.-06 <br />1,267.64 <br />9,5.5.11 <br />21 <br />— —0'0 — <br />09 -30 -00 <br />i <br />Please retum to: <br />STATE OF NEBRASKA <br />DEPARTMENT OF REVENUE <br />1S 11 WEST 2" ST STE 460 <br />GRAND ISLAND NE 69803 <br />T <br />TOTAL <br />$ 10,783.75 <br />- -• -•° •-- - --^° --w° ° �— N °� �—wuu mu oompneo wan rte revenue ISM of the State o} Nebraeks In the tl�erminetion <br />of the amountehawn to be due, and life taxpayer has felled to pay ft amount due alter demand, If this Notice of State Tax Lien is an extension of <br />an effective Gan, It selves continue the prlorkyr of the state's Interes the affected prop" of the taxpayer, <br />sign �U,3 <br />here Preparers lure Tit Oats Telephone No. <br />�AAthorized r , <br />A <br />Dell oF <br />NEBRASKA DEP I c* E OF REVENU to antl Goltleftrod Copies TAXPAYER - Pink Copy COUNTY OFFICE - Canary Copy t <br />otdod - --)-W pqu.r 44 .m <br />4x74 Rev. tp-66 6upod.e 4- 464.74 Rev. 6 -e6 ry <br />It `l <br />