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12/19/2001 17:53 FAX 14024714429 NEBRASKA UCC <br />F <br />Please rdum to: <br />STATE OF NEBRASKA <br />DEPARTMENT OF REVENUE <br />1811 WEST 2'ID ST STE 460 <br />CRAND ISLAND NE 68803 <br />Or <br />m6reeka <br />clepartmem <br />of revenue <br />fa 003/003 <br />$9031e4345 -0 Put: 1 <br />Fiilled:012P1R1912001 02:36 PM <br />200113130 <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 of <br />Revenue for unpaid taxes pursuant to the revenue laws of the state of <br />Nebraska. Notice fs 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 in <br />the county for real and personal property belonging to the taxpayer or <br />hereafter acquired. <br />Nebraska Identification Number Lien Rled With Social Security or Federal L0. Number Spouses Social Security Number <br />8133794 Register of Deeds ❑ county Clerk 507-04-9740 <br />Uen Seriai Number Lien Type Data of Lien Count <br />01/12/319 OrUnal ❑ Contmatbn E) Corrected 12 -13 - 01 HALL <br />BUSINESS NAME AND LOCATION ADDRESS I TAXPAYER NAME AND MAILING ADDRESS <br />Business Name Name <br />THE OASIS GARY R LEMBURG <br />Street Address Street or Other Mallkg Address <br />205 E HWY 2 1322 W 8TH ST <br />City State Zp Code City State Zp Code <br />rlAT1Zn Mr AAA2d 1 GRAND ISLAND NE 68801 <br />Tu>bt <br />Category <br />Tax Period <br />Date of <br />Amount of Tax <br />Pe"Ity <br />IrHKa91 <br />Additions <br />Balance of <br />Assessment Due <br />Number <br />I hereby certify that the Nebraska Department of Revenue has compiled with the revenue laws of the State of Nebraska in the determination <br />of the amount shown to be due, and the taxpayer has failed to pay the amount due after demand. if this Notice of State Tau Lien is an extension of <br />an effective Tien, it serves to conllrue the priority of the ante's interest i e affected properly of the taxpayer. <br />sign <br />c <br />here FPreparer'sSignatre Too Data lelephoneNo. <br />zed T ate <br />NEBRASKA DEPARTM94T Of REVENUE • Me and Goldenrod Copies TAXPAYER - Pink Copy COUNTY OFFICE - Canary Copy <br />,pa, . v.16d PW- 444&76 Fl v. 10-96 Supamedae 4-494.74 Rev. 5 -95 V <br />