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06 %28/2001 17:07 FAX 14024714429 <br />�!r <br />nepasMa <br />of rwwwa <br />NEBRASKA UCC <br />200106412 <br />Z 004 /004 <br />NE SL'C Of jk11lU 1I1111lIHllltll111��11� <br />I llilll Illll IIll1 <br />P9s: 1 <br />TAT GOLDEN GRAND 18LRND L L C <br />Fited_v06i28 /2001 ©4•,20 Pli <br />Notice of State Tax Lien <br />PLEASE DO NOT WRITE IN THIS SPACE <br />This Notice of State Tax Uen Is Issaed 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 dine from the taxpayer specified <br />below and remain unpaid after demand„ These taxes constitute a lien in <br />the county for real and personal prnpeirty belonging to the taxpayer or, <br />hereafter acquir8d. <br />Nebraska Identification Number <br />7863861 <br />Lien Filed VMh <br />[2 Register of Deeds ❑ County Clark <br />Sodel Seemly or Federal I.O. Number <br />91-1773482 <br />Spouse's Social Security Number <br />Lien Serial Number <br />Lien Type <br />Date of Lien <br />County <br />01/06/353 <br />(jo*w- ❑contnuation ❑cow i <br />06 -26 -01 <br />HALL <br />BUSINESS NAME AND LOCATIO14 ADDRESS <br />TAXPAYER NAME AND MAILING ADDRESS <br />8usinew Name <br />Name <br />TRI— GOLDEN GRAND ISLAND, L.L.C. <br />Street Address <br />Stoat or Otiwr MaiNng Addracc <br />4602 PLETTNER LANE <br />4A <br />City Stara <br />Zip Code <br />City Sbta <br />Zip Code <br />EVERGREEN CO <br />80439 <br />at4:sot <br />mtubbeerr <br />Taft Period <br />Amount of Tax <br />penalty <br />Interest <br />Adddlons <br />Balance <br />Atuessmen �� <br />04 -01 -01 - <br />1 <br />-01 <br />0 - -01 <br />5125-60 <br />512.5 <br />40.44 <br />5676.60 <br />Pleasn rebuato: <br />,STATE OF NEBRASKA <br />DEPARTMENT OF REVENUE <br />- 18 11 WEST 2ND ST STE 460 <br />GRAND ISLAND NE 68803 <br />L <br />5678.60 <br />TOTAL <br />is <br />I hereby comfy that the Nebraska Gtparbnent of Revenue has complied with the revenue fawn of the State of Nebraska in the detenr>Ination <br />of the amount show to be due, and the taxpayer has tailed to pay the amount due otter demand. If this Notice of State Tax Lien is an extenalon of <br />an effective Non, it rvos to cony s the priority of the sfata's interas the affected property of the taxpayer. <br />sign <br />here Progmw a e Date f Teftho NO <br />ad — e <br />gy�pp,, <br />NEBRAAA DEPARTM F REVENUE - and Goldenrod Copies TAXPAYER • Pink Copy COUNTY OFFICE - Canary Copy <br />6d 1 ad On mcy d OIPr 4 494 74 Rev. 10-95 SupWoodds 4 49474 Rev. see <br />