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06/12/2003 16:00 FAX 14024714429 <br />r 'ri <br />Please return to: <br />STATE OF NEBRASKA <br />DEPARTMENT OF REVENGE <br />1811 NEST 2"D ST STE 460 <br />GRAND ISLA_N1D NE 68803 <br />NEBRASKA UCC <br />U002/003 <br />No sae of sk.i• • urc SU <br />9203286103 -5 Pon: 1 <br />D.C. SUB. lNC. <br />Filed: 06/11/2003 33;49 PN <br />200307487 <br />r NOTICE OF STATE TAX LIEN <br />npD +OSk► <br />orRBhitnPMlt,4 <br />PLEASE DO NOT WRITE IN THIS SPACE <br />This Notice of State Tax Lien is issued by the Nebraska Department of <br />Revenue for unpaid taxes pursuant to the revenue laws of the state of i <br />Nebraska. Notice is hereby given that taxes including penalties and. <br />interest, which are shown below, are due from the taxpayer specified i <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 acquired. <br />Nebraska Identification Number Lien Filed With Social Security Number Spouse's Social Security Number <br />8396957 QX Register of Deeds [] County Clerk <br />Lien Serial Number Uen Type Date of Lien County <br />. <br />E] Original ❑ Continuation 7 Corrected May 31, 2003 Hell <br />BUSINESS NAME AND LOCATION ADDRESS TAXPAYER NAME AND MAILING ,ADDRESS <br />Business Name Name <br />D.C. Sub, Inc. <br />Street Address Street or Other Mailing Address <br />1919 Sheridan Ave <br />Ciy State Zip Code City State Zip Code <br />Grand Island NE 68803 <br />Tax <br />Ob /01102 thru <br />09/06/2002 <br />256.39 <br />51.41 <br />tegory Tax Period <br />rN'drnber <br />Date of <br />Amount of Tax <br />Pennity <br />Interest <br />Additions <br />Balance of <br />Assessment <br />0 <br />0 B/01 /02 thru <br />06/3112003 <br />2,000.00 <br />Assessment Due <br />01 <br />Ob /01102 thru <br />09/06/2002 <br />256.39 <br />51.41 <br />307.80 <br />07/31/2002 <br />0 <br />0 B/01 /02 thru <br />06/3112003 <br />2,000.00 <br />400.00 <br />97.48 <br />2,497.48 <br />08/31/2002 <br />09/01/02 thru <br />01 <br />2 <br />09/30/2002 <br />05/31/2003 <br />2,000.00 <br />400.00 <br />82.58 <br />2.482.68 <br />10/01/02 thru <br />01 <br />10/31/2002 <br />05/31/2003 <br />200.00 <br />45.00 <br />6.74 <br />251.74 <br />7101!02 thru <br />21 <br />09/30/2002 <br />06/31/2003 <br />546.46 <br />136.62 <br />21.78 <br />704.86 <br />21 <br />10/01/02 thru <br />05/31 /2003 <br />60.00 <br />26.00 <br />1.24 <br />86.24 <br />2/31 /2002 <br />TOTAL <br />$ 6,330.80 <br />1 hereby certify that the Nebraska Department of Revenue has complied with the revenue laws of the State of Nebraskan the - <br />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 <br />Tax Lien is an a ension of an effective lien, it serves to continue the priority of the state's interest in the affected property of the taxpayer. <br />- 308 385 -6074 <br />t� 2 . - Revenue Agent [Q- 613 <br />-p7cne <br />sign p a s Signature Title Date 7eT Number <br />here Revenue Senior Agent r7 g -113 <br />Authorized Sig ature Title Date._ = <br />4- 494.1574 Rev. 2 -2002 gger dac 4- 474 -1774 RQv. 17• -995 <br />UI <br />4 <br />A <br />