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..04/20/2004 15:05 FAX 14024714429 X - doom". or NEBRASKA UCC 2004038.85 Z 002/003 NOTICE OF STATE TAX LIEN This Notice of State Tax Lien is issued by the Nebraska Department of PLEASE DO NOT 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 Filed With Social Security Number 27316254 Lien Serial Number 089049187 BUSINESS NAME AND Business Name Street Address city IN THIS SPACE XQ Register of Deeds o County Clerk 507 -80 -7510 Lien Type Date of Lien County Original XO Continuation Corrected 02/18/1989 HALL TION ADDRESS TAXPAYER NAME AND MAILING ADDRESS Name BEN VALDEZ Street or Other Mailing Address 515 NORTH VINE STREET Zip Code City Category Tax Period Date of Amount of Tax Number Assessment 22 1984 12/15/1988 10431 GRAND ISLAND Penalty Interest 5.22 1 56.77 State Zip Code NE 68801 Additions Balance of Assessment C 166.30 TOTAL $ 166.30 I hereby certify that the Nebraska Detpartment of Revenue has complied with the revenue Paws of the Stafe 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 an extension of an effective lien, It serves to continue the priority of the state's interest in the affected property of the taxpayer. - h ' �-� Revenue Agent l9'C�y 402 471 -58351 f` 1 sign Prepare 's Signature Title N ho l eepne umber here Date T � � _ _ � I orizedSignatur" -Title J Date