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05/19/2004 09:39 FAX 14024714429 NEBRASKA UCC <br />�f <br />r� <br />Or <br />200404999 <br />o• , <br />Q002/003 <br />FABER <br />Filed: <br />scoN <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 = 2j— IVt-u 101 <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 due from the taxpayer specified <br />below and remain unpaid after demand. These taxes constitute a lien <br />in the county for real and personal property belonging to the taxpayer <br />or hereafter acquired. Cis t 3 /Ci 101 �� f <br />Nebraska Identification Number Lien Filed With Social Security Number use "s•social-Sedurity Number - <br />35531673 XL�I Register of Deeds ❑ County Clerk 513 -54 -6861 <br />Lien Serial Number Lien Type Date of Lien County <br />923590077 [:]Original X❑ Continuation ❑ Corrected 03/1011993 HALL <br />BUSINESS NAME AND LOCATION ADDRESS TAXPAYER NAME AND MAILING ADDRESS <br />Business Name Name <br />WALTER GERALD FABER <br />Street Address Street or Other Mailing Address <br />226 ARAPAHOE <br />City State Zip Code City State Zip Code <br />WICHITA KS 67209 <br />Tax <br />Category <br />Tax Period <br />I <br />Date of <br />I <br />Amount of Tax <br />I <br />Penalty <br />I <br />Interest <br />I <br />Additions <br />I <br />Balance of <br />I <br />Number <br />Assessment <br />Assessment Due <br />22 1985 12/14/1992 3,410.00 852.50 3,252.20 7,514.70 <br />22 1986 12114/1992 1,736.03 434.01 1,412.66 3,582.70 <br />I I TOTAL I$ 11,097.4 <br />1 hereby certify that the Nebraska Department of Revenue has complied with the revenue laws of the State of Nebraska in the <br />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 <br />Ta �'an 'on of an fective `lie�n, it serves to continue the priority of the state's interest in the a eted property of the taxpayer. <br />(�La Revenue Agent 5-1 402 - y7 f - 5 93S <br />sign Preparer's Signature Tile Date Telephone Number <br />here _ _ {F 6x?-_ Al _7 <br />qdt orized Signature Title Date <br />I <br />