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07/02/2004 16:49 FAX 14024714429 NEBRASKA UCC 0 002/003 <br />0S <br />Or <br />200406697 <br />I PM <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 jh ; 4 1%$ <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. <br />Nebraska Identification Number Lien Filed With Social Security Number Spouse's Social Security Number <br />39467783 ❑ Register of Deeds ❑ County Clerk 508 -40 -1833 <br />Lien Serial Number Lien Ty Date of Lien County <br />980100205 Or ❑ Corrected 1 05/11/1998 HALL <br />BUSINESS NAME AND LOCATION ADDRESS TAXPAYER NAME AND MAILING ADDRESS <br />Business Name Name <br />JAMES L GUSTAFSON <br />Street Address Street or Other Mailing Address <br />PO BOX A <br />City State Zip Code City State Z1p Code <br />r rWIPHAN NE 68832 <br />Tax <br />Category <br />Tax Period <br />Date of <br />Amount of Tax <br />Penalty <br />Interest <br />Additions <br />Balance of <br />Assessment Due <br />Number <br />1987 <br />Assessment <br />1,025.00 <br />256.25 <br />1,130.23 <br />2,411.48 <br />22 <br />1986 <br />11/24/1997 <br />720.48 <br />180.12 <br />895.59 <br />22 <br />1987 <br />11/24/1997 <br />1,025.00 <br />256.25 <br />1,130.23 <br />2,411.48 <br />22 1988 11/24/1997 1,652.00 413.00 1,589.68 3,654.68 <br />22 1989 11124/1997 4,782.33 1,195.58 3,934.21 9,912.12 <br />22 1990 11124/1997 903.00 225.75 616.44 1,745.19 <br />22 990 thru 199 11/24/1997 2,261.00 565.25 1,009.40 3,835.65 <br />TOTAL $ 23,355.31 <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 />Tax lien is an extensi of an effecti lien, it serves to continue the priority of the state's interest in the affected property of the taxpayer. <br />Revenue Agent (�—�J`� 402 471 -5835 <br />sig n Ampr Ns i nature Title Date Telephone Number r.' <br />here <br />Date <br />uthorized igna re <br />Title ;J. <br />