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LY <br />1 <br />r, <br />1 <br />05/'30;2003 11:37 FAX 14024714429 NEBRASKA UCC 17j002/003 <br />20030'7047 <br />sl•a - ucc sn <br />77MOI -1 Pas: 1 <br />COOKIE CORNER INC. <br />06129/2003 12.14 PM <br />Please return to: <br />STATE OF NEBRASKA <br />DEPARTMENT OF REVENUE <br />1811 WEST 21 ST STE 460 <br />GRAND ISLAND NE 68803 <br />Or NOTICE OF STATE TAX LIEN <br />nomsia <br />at rA7 kiYd <br />PLEASE DO NOT WRITE IN THIS SPACE <br />This Notice of Stage Tax Lien Is Isausd by the Nebraska Department of <br />Revenue for unpaid taxes pursuant to the revenue taws of the state of <br />Nebraska. Notice is hereby given that taxes including penalties and <br />interest, which are shown below, are due from the taxpayer specifled <br />below and remain unpaid after demand. These taxes constitute a lien <br />In the county for real and personal property belonging to the taxpayer <br />or hereafter ac utreo. <br />Nebraska Idendfivation Number Lien Filed With <br />Federal Idencation Number <br />Social Security Number <br />6349900 <br />Q Register of Deeds County Clerk 47- 0746741 <br />Lien Serial <br />tuber <br />Lien Type <br />Date of Lien <br />County <br />0 3 <br />QX Original ❑ Continua_t on ❑Corrected 05/28/2003 <br />Hall <br />BUS! ESS NAME AND LOCATION ADDRESS <br />TAXPAYER NAME AND MAILING ADDRESS <br />Business-Name <br />Name <br />Nancy's Cookie Corner, Inc.. <br />Street or Other Mailing Address <br />Street Address <br />1004 Diers Ave; Suite 214 <br />City <br />State Zip Code i <br />City <br />State <br />Zip Code <br />Grand Island <br />NE <br />68803 <br />=Tax <br />ax Period <br />Date of Amount of Tax <br />Penalty Interest Addltlons <br />Assessm nt Due <br />I <br />Assessment <br />0i <br />04101/2002-1 <br />12/0512002 76.40 <br />49.11 4.23 <br />5.00 <br />134.74 <br />09/30/2002 <br />01 <br />10101 12002 - <br />05/03/2003 1,000.00 <br />12.17 <br />0.00 <br />1,212.17 <br />03/12/2003 <br />01 <br />01101 /2000- <br />03131/2003 <br />1 8,583.00 <br />#47.41 <br />2,910.81 <br />0.00 <br />25,210.81 <br />09/30/2002 <br />21 <br />04101/2002- <br />11/08/2002 <br />264.98 <br />14.81 <br />5.00 <br />i 332.20 <br />09/3012002 <br />21 <br />10101/2002- <br />05/03/2003 <br />500.00 <br />37.50 <br />7.90 <br />545.40 <br />03/12/2003 <br />67 <br />07/01 /1997- <br />03/31/2003 <br />- 266.00 <br />152.00 <br />64.44 <br />482.44 <br />0613012002 <br />TOTAL <br />$ 27,917.76 <br />f Nebraska <br />in the <br />Sign <br />here <br />I hereby certify that the Nebraska Department of Revenue has complied with the revenue la <br />e taxpayer has falled to pay the amouws of the Stale o - -- <br />determination of the amount shown to be due, and thnt due after demand. If this Notice of State r <br />Tax Lien Is an extens on of an effective lien, it serves to continue the priority of the state's interest in the affected property of the taxpayer. <br />I_ Dexter <br />67b 308 385 -6073 <br />ZPreparers,& nat6re / Title Date el9 ne N tuber Revenue Senior Agent <br />Title ate o[ a Sig U & 4- 494 -1974 Rev. 2.2002 Supereades 4. 494.11974 Rev. 0-1 SS6 <br />V <br />