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09/28/2004 14:53 FAX 14024714429 NEBRASKA UCC 200409500 41010"M : Of 14 002 N[ See of i+.fi. - UM icon 9904362370 -3 Pos: 1 K DANIEL J Filed: 09/27/2004 03:47 PM NOTICE OF STATE TAX LIEN dll�! IIZYI #v 9 6- /0133 — C /n5;tY 4:p-) 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 acquired. DO NOT WRITE IN THIS SPACE Nebraska Identification Number L Lien Filed With Social Security Number S Spouse's Social Security Number 38416263 E E Register of Deeds E] County Clerk 505 -80 -2136 Lien Serial Number L Lien Type _ Date of Lien C County 962920035 0 _ D 09/13/2004 H HALL BUSINESS NAME AND LOCATION A ADDRESS T T______T XPAYER NAME AND MAILING ADDRESS Business Name N Name DANIEL J KROLIKOWSKI Street Address S Street or Other Mailing Address 4017 CENTRAL AVE City State Zlp Code C City State Zip Code KEARNEY NE 68847 Tax K Category Tax Period Date of Amount of Tax P Penalty Interest Additions Balance of Assessment Due 22 1 1991 0 08/26/1997 2 253.00 7 73.95 8 844.24 1 1,171.19 22 1 1992 0 09/26/1997 1 19,229.57 1 1,609.95 1 18,130.58 3 38,970.10 TOTAL $ $ 40,141.29 epartment 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 k Tax Lien is an extension of a effective lien, it serves to continue the priority of the state's interest in the affected property of the taxpayer. ► Revenue Agent — 402 471 -5835 sign Preparer's Signature Title Date Telephone Number here ► �� %�.�.� A thorized Signatur Title Date I