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09/24/2004 15:10 FAX 14024714429 NEBRASKA UCC 200409465 10005/005 - -,,l PM NOTICE OF STATE TAX LIEN This Notice of State Tax Lien is issued by the Nebraska Department of PLEASE DO NOT WRITE IN THIS SPACE 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 Federal Identification Number 16441893 Lien Serial Number Lien Filed With Social Security Number Spouse's Social Security Number ID42470161 XQ Register of Deeds o County Clerk 505 -70 -7868 Date of Lien i Lien Type County 09/20/2004 XD Originaf 0 Continuation Corrected HALL BUSiNtSS NAME AND LOCATION ADDRESS TAXPAYER NAME AND MAILING ADDRESS Business Name Name HARVEY L MEYER Street Address Street or Other Mailing Address 452 DENTON RD City State Zip Code City State Zip Code Tax -' �•""' NYC 00014 Category Number Ta4eriod Date of Amount of Tax Penalty Interest Additions Balance of Assessment Assessment Due 22 1 1 09/0412004 2,958.00 251.90 76.83 3,286.73 ;2003 TOTAL $ 3,286.73 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 lien, it serves to continue the priority of the state's interest in the affected property of the taxpayer. ;� M -%/�A 01) REVENUE AGENT q-)4-0,1 402 471 -5835 sign Preparers Signature Title Date Telephone Number here 10. �� , - Z S.vio,� ,�wT 7- L /--ay I. uthorQed Sign re Title Date