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06/18/2004 14:07 FAX 14024714429 rj Or A* NEBRASKA UCC Q 003 /003 Of Urc S[ON 13aa79 -3 Pas: 1 KEITH MI M11812004 11:41 AM 200406205 NOTICE OF STATE TAX LIEN 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. PLEASE DO NOT WRITE IN THIS SPACE JtOMI Ml #-r: 9 ,5 - /0767.�2 1 Nebraska Identification Number Lien Filed With Social Security Number - Sjp'ouse's Social Security Number 26754142 X❑ Register of Deeds E] County Clerk 559 -02 -9777 Lien Serial Number Lien Type.. ) Date of Lien County 950130416 Q Origi 'Q Continuation _,"[corrected 11/01/1995 HALL BUSINESS NAME AND LOCATION AD .RESS ..- - "' F TAXPAYER NAME AND MAILING ADDRESS Business Name Name KEITH M VALUER Street Address Street or Other Mailing Address 2828 UPSHUR ST APT 202 City State Zip Code City State Zip Code SAN DIEGO CA 92106 Tax Category Tax Period I Date of I Amount of Tax I Penalty I Interest I Additions I Balance of Number Assessment Assessment Due 22 I 1993 1 09/27/1994 I 577.67 1 65.98 I 436.18 I I 1,079.83 I I I I TOTAL I$ 1,079.83 1 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 pn extensi of an eff e a lien, It serves to continue the priority of the state's interest ' the offected property of the taxpayer. ! Revenue Agent (� %� �,. 402 471 -5835 sign PXthohzed 's igna ure Title Date Telephone Number + here �d,� i...,,r i r2 Signat e rifle Date r I