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07/14/2004 08:33 FAX 14024714429 NEBRASKA UCC IM 003 /003 r 200406921 OrNotice of State Tax Lien nebraska department Of revenue PLEASE ISO NOT WRITE IN THIS SPACE INDIVIDUAL INCOME TALC SOCa SEC* NO* 622505015 NE.BR* IDENTa NOe 38053441 SPOUSE SOCa SEC. NOa TAXABLE YEAR 2000 LIEN NO* 040720D92 COUNTY BALL L_AURIANO R R,ABANAL.ES B DATE OF NOTICE 03/12/2004 427 E MALL ST DATE OF ASSESSMENT 01127/2004 GRAND ISLAND Pic 6.3801 THIS NOTICE OF STATE TAX LIEN IS ISSUED BY THE NEBRASKA DEPARTMENT OF REVENUE FOR INDIVIDUAL INCOME TAX PURSUANT TO THE REVENUE LAWS OF THE STATE OF NEBRASKA, NGTICE IS ;HEREBY GIVEN THAT INDIVIDUAL INCOME TAXES INCLUDING PENALTIES AND 114TERESTY WHICH ARE SHOWN BELOW ARE DUE FROM THE TAXPAYER SPECIFIED ABODE- AND REMAIN UNPAID AFTER DEMAND- THESE TAXES CONSTITUTE A LIEN IN THE COUNTY FOR PROPERTY SEL3NGING TO THE TAXPAYER OR HEREAFTER Ar-QJlR =D* AMOUNT Of TAX a a a a a a a a a s a a a a a a s a 186a00 PENALTY • a a o a a a• a a• a a a a a a a a a a 9a30 INTEREST (COMPUTED TO 03/22/2004) a a a a a a a a 42oD3 TOTAL AMOUNT DUE . a.. a a. a a a a a r a a a 237.33 I HEREBY CERTIFY THAT THE NEB;ASKA DEPARTMENT OF REVENUE HAS COMPLIED WITH THE REVENUE LAMS OF THE STATE OF NEBRASKA IN THE DETERMINATION DF T E AMOUNT SHOWN TO BE DUEv AND THE TAXPAYER HAS FAILED TO PAY THE A14OUNT 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 STATEWS INTEREST TM T14F AFFr -rTr3; 02rpri?Ty n;: rm: TAXPAYER= PR— RE.Rgsaa GNAT aE a• aaaara..aaaaaraaa: THORIZEs3 �� I k.A T URE as rara.aaaa **40*& TIT 4 sa�aasa .saa•aasaaa :aa• TITLE qw) -C 0AT`°1 ELLPHt)'hE aaaa•a.aaaaaa.aar• DATE NEBRASKA DEPARTMENT OF REVENUE - White and Canary Copies TAXPAYER - Pink Copy Printed with soy ink on recycled paper 7- 145 -1979 Rev. 2 -2000 Supersedes 7 -146 -1979 Rev. 10 -1995