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03/16/2004 16:51 FAX 14024714429 NEBRASKA UCC Q003/008 tlHe uCC ICON i i i i !21 -3 Poo: I F DEAN A j /16/2004 03:09 PM 20040.2567 NOTICE OF STATE TAX LIEN DO 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 lien in the county for real and personal property belonging to the taxpayer or hereafter acquired. Nebraska Identification Number Lien Fled With Social 6611q-111 11635568 X❑ Register of Deeds [] County Clerk 505 -52 -9505 508 -48 -2092 Lien Serial Number Lien Type ,,_ - -- ---- . Date of Lien County 089223312 ginal X]Continuation .) []Corrected ,12115/1989 HALL BUSINESS NAME AND LOCATIONXISDRESS--1 TAXPAYER NAME AND MAILING ADDRESS Business Name Name DEAN & SHERYL TESSENDORF Street Address Street or Other Mailing Address 604 EAST GROFF STREET City State Zip Code City rRVnln Icl onln nt State Zip Code Tax Tax Category Tax Period Date of Amount of Tax Penalty Interest Additions Balance of Number � Assessment Assessment Due 22 1 1988 1 05/24/1989 1 222.00 I 11.10 I 20.79 I 1 253.89 TOTAL $ 253.89 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 Lien is qin exteosion of effectiv li n, it serves to continue the priority of the state's Z interes in the affected property of the taxpayer. 5 . �G 402'471 -583 Revenue Agent" � .d � . Sign Pes Sinatur Title .. p. ri� 11 here L Revenue Supervisor horized Sig fore . - Title Date