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07.122/200316:31 FAX 14024714429 NEBRASKA UCC <br />6� <br />it <br />noatirsok► <br />mgtse+an►MOa <br />or ieraaa.► <br />Please reran to: <br />STATE OF NEBRASKA <br />DEPARTMENT OF REVENUE <br />1811 WEST 2ND ST STE 460 <br />GRAND ISLAND NE 68803 <br />Z 002/003 <br />No a.. Or aaa. - UCC sTL <br />9903266725 -3 Pas: 1 <br />HOUGH DOUGLAS A. <br />Filed: 07122/2003 01:19 PM <br />NOTICE OF STATE TAX LIEN <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 <br />Nebraska. Notice is hereby given that taxes Including penalties and <br />interest, which are shown below, are due from the taxpayer specified <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 <br />Lien Flied With <br />Social Security Number <br />Spouse's Social Security Number <br />8390754 <br />XQRegister of Deeds <br />[]Courty Clerk <br />507 -90 -0105 <br />Lien Seri 1 Number <br />Lien Type <br />Date of Lien <br />County <br />Z❑X <br />Original Continuation Corrected 07/12/2003 <br />Hall <br />BUSINESS NAME AND LOCATION ADDRESS <br />TAXPAYER NAME AND MAILING ADDRESS <br />Buslress Name <br />Name <br />Douglas A. Hough <br />Street Address <br />Street or Other flailing Address <br />120 East Third Street <br />City <br />State Zip Code <br />City <br />State <br />Zip Code <br />Grand island <br />- — - - - -- <br />NE <br />68801 <br />Tax <br />Category <br />Tax Period <br />Data of Amount of Tax <br />Penalty <br />Interest <br />Additions <br />Balance of <br />Number <br />Assessment I <br />Assessment Due <br />01 <br />09101/2002- <br />07/12/2003 <br />2,973.31 <br />320.12 <br />147.06 <br />3,440.49 <br />02/23/2003 <br />07/01/2002 <br />21 <br />12/31/2002 <br />07/12/2003 <br />699.01 <br />118.37 <br />38.74 <br />856.12 <br />01/0112003 <br />21 <br />02/08/2003 <br />07/12/2003 <br />114.17 <br />-0- <br />1.37 <br />115.54 <br />TOTAL <br />$ 4,412.15 <br />I hereby certify that the Nebraska Department of Revenue has complied with the revenue laws of the State of Nebraska in the <br />determinatlon of the amount shown to be due, ano the taxpayer has failed to pay the amount due after demand. If this Notice of State <br />Tax Lien is an extension f an eff ctive lien, it serves to continue the priority of the state's interest in the affected property of the taxpayer, <br />Revenue Senior Agent )0-3 308 385 -5073 <br />Sign P pacers Signallure Title Date Telephone Number <br />here Revenue Supervisor le� A3 <br />u orize i n to a Title to <br />4-494-1974 Rev. 2 -2002 Supersedes 4. 4941974 Rev- o 1995 <br />1 <br />l <br />1.. <br />