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07/21/2003 11:47 FAX 14024714429 NEBRASKA UCC Z002/003 c Or h*r of 1*011iow 210309428 STL :36 PM NOTICE OF STATE TAX LIEN 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 Lien Filed With Social Security Number Spouse's Social Security Number 22605894 X❑ Register cf Deeds � County Clerk 506 -64 -3732 506 -88 -6794 Len Sena] Number Lien Type Date of Lien County 030450177 QOnginal ❑Continuation ❑Corrected 07/07/2003 Hall BUSINESS NAME AND LOCATION ADDRESS TAXPAYER NAME AND MAILING ADDRESS BLSiness Name IName Thomas P & Karen Mettenbrink Street Addness Street or 73thar Mailing Address 1324 W North Front St City State Zip Cade City State Zip Code I Grand Island Nebraska &88101 Tax Category Tax Period Date of Amount of Tax Penalty Interest Additions Balance of Number Assessment Assessment Due 22 2001 11/12/2002 1,668.00 99.40 158.48 1,925.88 22 2002 05102/2003 807.00 40.35 11,01 858.36 TOTAL 1$ 2,784.Ft I 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 extension oia ctive lien, it ss rves to continue the priority of the state's interest in the affected property of the taxpayer. ., ter✓ Revenue Agent —/( O� 402 471 -5836 Sig Prep ignatr Title Date Teiepho a um r here 0 r Revenue Supervisor �� Aut nzed Signiiturb Title Date is -1