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08/30/2004 11:08 FAX 14024714429 NEBRASKA UCC )7r q Please return to: 200408653 STATE OF NEBRASKA DEPARTMENT OF REVENUE 1811 WEST 2f'n ST STE 460 411002/002 GRAND ISLAND NE 68803 Or 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 or hereafter acauired. Nebraska Identification Number Lien Filed With Social Security Number Spouse's Social Secunty Number 11610905 ❑X Register of Deeds ❑ County Clerk 505 -52 -3010 508 -54 -8592 Lien Serial Number Lien Type Date of Lien County 040510031 0 Original ❑ Continuation ❑ Corrected 08/26/2004 Hall BUSINESS NAME AND LOCATION ADDRESS TAXPAYER NAME AND MAILING ADDRESS Business Name Name . Jerry L & Carole L Denton Street Address Street or Other Mailing Address 205 S Cedar City State Zip Code City State Zip Code Grand Island NE 68801 pax Category Tax Period Date of Amount of Tax Penalty Interest Additions Balance of Number Assessment Assessment Due 22 2002 12/03/2003 46,840.00 4,806.00 3,842.16 55,488.16 TOTAL I$ 55,488.16 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 an extension of an effective 'en, it serves to continue the priority of the state's interest in the affected property of the taxpayer. ell 7` Revenue Agent 8' 308 385 -6074 sign 111101 Pre arer's Signature Title Date Telephone Number here Revenue Supervisor 4v__ on d n to Title to