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03/16/2004 16:50 FAX 14024714429 i #04~ NEBRASKA UCC IM 002/008 N� Sic sf S!�!• - UCC - ICON I 9904323217 -4 pee: t MILLER JoFNd I F116d; 03/15/2004 03:09 PM 200402566 NOTICE OF STATE TAX LIEN PLEASE DO NOT WRITE IN This Notice of State Tax Lien is issued by the Nebraska Department of Revenue for unpaid taxes pursuant to the revenue laws of the state of Nebraska. Notice is hereby given that taxes including penalties and interest, which are shown below, are due from the taxpayer specified below and remain unpaid after demand. These taxes constitute a Ilan in the county for real and personal property belonging to the taxpayer or hereafter acquired. �� A Nebraska Identification Number Lien Filed With Social Security Number Spouse's ocial.See 27545377 X❑ Register of Deeds E] County Clerk 505 -54 -4656 Lien Serial Number Lien Type F ° — Date of Lien County 089062045 [] Orin ntinuafion Corrected 1 06/27/1989 HALL BUSINESS NAME AND LOCATION AD©R. S -- TAXPAYER NAME AND MAILING ADDRESS Business Name Name JOHN I MILLER Street Address Street or Other Mailing Address 811 WEST 11TH STREET City State Zip Code City State Zip Code GRAND ISLAND NF RAWYA ��F Tax Category Tax Period I Date of Amount of Tax Penalty Interest Additions Balance of Number Assessment Assessment Due 22 1984 01/12/1989 22 1985 10/04/1988 232.80 11.64 136.97 191.00 9.55 85.64 381.41 286.19 TOTAL $ 667.60 I hereby certify that the Nebraska Department of Revenue has complied with the revenue laws of the State of Nebraska in the determination of the amount shown to be due, and the taxpayer has failed to pay the amount due after demand. If this Notice of State Tax LieMisn te nsio f an effec iv lien, it serves to continue the priority of the state's Interes in th affected property of the taxpayer. Revenue Agent 402 471 -5835 sign Preparer's Signature - Title Date Telephone Number here Revenue Supervisor na of Title Date oozed Sig t a