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07/20/2004 08:34 FAX 14024714429 JAS Or 11 ,1"011000 60 NEBRASKA UCC 200407160 IM 002 NOTICE OF STATE TAX LIEN This Notice of State Tax Lien is issued by the Nebraska D.epartment.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. Nebraska Identification Number Lien Filed With Social PLEASE DO NOT WRITE IN THIS SPACE Spouse's Social Security 22975926 XQ Register of Deeds X❑ County Cierk 505 -76 -7637 507 -80 -4374 Lien Serial Number Lien Type Date of Lien County 951110017 Original Continuation Ej Corrected 08/25/1995 HALL BUSINESS NAME AND LOCATION ADdRE TAXPAYER NAME AND MAILING ADDRESS Business Name Name GERALD A & ANGELA M BEYERSDORF Street Address Street or Other Mailing Address 518 E CAPITOL_ AVE 57 City State Zip Code City State Zip Code C.RANI7) IRI ANn kit= anan-1 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 1 1991 1 02/13/1995 1 205.37 1 11.25 1 66.80 I 1 283.42 TOTAL 1 $ 283.42 1 hereby certify that the Nebraska Department of Revenue has complied wlth 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 Ep xtensionfan effectiv lien, it serves to continue the priority of the state's interest in the affected property of the taxpayer. f .: 402 471 -5835 Revenue Agent G - zi - a y C= sign Preparer's Signature Title Date Telephone Number here ► Ad SignA 7 - --r-1 GUIL Date �� 7Tdl^ulRetr�>Irc LJ