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10/15/2004 15:54 FAX 14024714429 NEBRASKA UCC 20041'0193 Q002 Or NOTICE OF STATE TAX LIE 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 acquired. Nebraska Identification Number Federal Identification Number 36541826 Lien Serial Number Lien Filed With Social Security Number Spouse's Social Security Number 41490042 El Register of Deeds 11 County Clerk 480 -96 -7686 508 -98 -6077 Date of Lien Lien Type County 05/28/2004 QOriginal IlConiinuation Corrected HALL BUSINESS NAME AND LOCATION ADDRESS TAXPAYER NAME AND MAILING ADDRESS Business Name Name NICHOLAS K & TERRIE A STANGLER Street Address - Street or Other Mailing Address 138 MELODY LN City State Zip Code City State Zip Code Tax GRAND ISLAND NE 68803 Category Tax Period Date of Amount of Tax Penalty Interest Additions Balance of Number Assessment Assessment Due 22 2003 05/28/2004 166.30 41.58 11.15 219.03 I I I I I TOTAL +$ 219.03 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 's an exten 'on of an eefferptive lien, it serves to p, "nue the prWX interest in the affect d property of the taxpayer. 402 sign Prepar is Signature Title' Date Telephone Number h e re �.e ,-t , uthorized Signature Title Date L