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07/23/2004 16:47 FAX 14024714429 NEBRASKA UCC Ir 200407337 [003 104:06 PM NOTICE OF STATE TAX LIEN PLEASE DO NOT WRITE IN THIS SPACE 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�S�a� or hereafter ac uired. Nebraska Identification Number Lien Filed With Social Security Number Spouse's Social Security Numb' 34038876 XI Register of Deeds XQ County Clerk 563 -47 -7402 Lien Serial Number Lien Type Date of Lien County 943140097 ❑ on ' X Continuation Corrected 11/10/1994 HALL BUSINESS NAME AND LOCATION ADD TAXPAYER NAME AND MAILING ADDRESS Business Name Name ALVINA CORTIZZ Street Address Street or Other Mailing Address 120 W ASHTON City State Zip Code City State Zip Code r_RnNn Icl &mn NF 68801 Tax Category Tax Period Date of Amount of Tax Penalty Interest Additions Balance of Assessment Due Number Assessment 22 1 1990 1 09/26/1994 I 1,163.00 I 58.15 I 430.69 I I 1,651.84 TOTAL 1$ 1,651.84 I 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 an extension an effective en, it serves to continue the priority of the state's interest in�� the ��affected property of the taxpayer. Revenue Agent ;C U� 402 471 -5835 '� sign Prepay s Signature Title Date Telephone Number here a ��,� _7 -zi -oy thorized Signa re T44/- i Date