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04!16/2001 16:22 FAX 14024714429 NEBRASKA UCC a002 <br />Iliilll�l.11IIE11lIllllllillilll (Ifllill' <br />{ 9901133793 Per 1 <br />l� TRI- GOLDEN GRAND ISLAND L L.0 <br />U Filwd 04/1612001 03.39 PM <br />Or <br />nabranlw <br />cle"rlraent <br />of r.wanua <br />200103380 <br />Notice of State Tax Lien <br />PLEASE DO NOT WRITE IN THIS SPACE <br />This Notice of State Tax Lien is issued by the Nebraska Department or <br />Revenue for unpaid taxes pursuant to the revenue laws of the state or <br />Nebraska. Notice ic hereby given that taxes including penalties and <br />interest, wbich are shown below, are due from the taxpayer specified <br />below and remain unpaid after demand. These taxes constitute a lien in <br />the county for real and personal property belonging to the taxpayer or <br />hereafter acualred. <br />Nebraska identification Number <br />7863861 <br />Lien Filed With <br />® Registrar of Deeds ❑ County Clerk <br />Social Security or Federal I. D. Number <br />Spouse's Social security Number <br />L ian Serial Number <br />01/04/327 <br />Lien Type <br />® Odginai ❑ Continuation ❑ Corrected <br />Date of Lien <br />04-11-01 <br />County <br />H ALL <br />BUSINE33 NAME AND LOCATION ADDRESS <br />TAXPAYER NAME AND MAILING ADDRESS <br />Business Name TRI —GOLDEN GRAND ISLAND, <br />Nam <br />L.L.C., D /B /A GOLDEN CORRAL <br />TRI— GOLDEN GRAND IST,AND, L_T,_C <br />SvsetAMMS <br />Street or Other Maitng Address <br />2435 N DIERS AVE <br />4602 PLETTNER LANE 4A <br />City State Zip Code <br />GRAND ISLAND NE 68801 <br />City Rate Zip Coda <br />EVERGREEN CO 80439 <br />Tax <br />ry <br />Tax PWlod <br />Date of <br />Assaasrnent <br />Amount of Tax <br />Penalty <br />Irhtereat <br />Additlorm <br />Balancer of <br />Num <br />AaaasamentDue <br />01 <br />11 -30 -00 <br />04 -09 -01 <br />5640 -7 <br />1 <br />12 -01-00 - <br />01 <br />1231 -00 <br />04 -09 -01 <br />ral 46 <br />1 <br />4_ <br />01 -01 -01 - <br />01 <br />01 -31 -01 <br />04 -09 -01 <br />0 <br />x097.79 <br />Please realm to: <br />STATE OF NEBRASKA <br />DEPARTMENT OF REVENUE <br />1811 WEST 2ND ST STE 460 <br />GRAND ISLAND NE 68803 <br />I <br />TOTAL <br />6.19.327.3; <br />. irw cur uwwy um, urn r vurema uepanmenr or movenue nas compaeo wrtn Ann revenue laws of the State of Ne&aska in the determination <br />of the amount shown to be due, and rho taxpayer has failed to pay the amount due niter demand. If this Notice cf Sure Tax Lien Ivan eXenslon of <br />W effeCtive len. R serves 10 continue the priority of the state's interact in the affected property the taxpayer. <br />sign r� yli� <br />here arer re Ttle cam T� eNo. <br />Ault dz e •tP 1� y /Z <br />Date <br />NEB le. DEPRRTM OF REVENUE—White and Goldenrod Copies TAXPAYER - Pink Copy COUNTY OFFICE - Canary Copy �7 <br />6 0ft '� ra�lerd Oar 4 -10-74 Rev 1 OS6 6upersed" 4- 40474 kw. G06 <br />t <br />