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07:'22/2003 16:31 FAX 14024714429 <br />0� <br />NEBRASKA UCC <br />a003 /003 <br />N9 sec of Elate - Dec LR <br />9=3286726 -5 <br />HQUGH MIA M <br />Filed: 07/22/2003 07:18 PM <br />20030-9468 <br />NOTICE OF STATE TAX LIEN <br />PLEASE DO NOT WRITE IN THIS SPAC <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 />Please return to: <br />STATE OF NEBRASKA <br />Spouse's Social Security Number <br />DEPARTMENT OF REVENUE <br />] Register of Deeds <br />1811 WEST_ 2N0 -ST STE 460 <br />50611 7433 <br />GRAND ISLAND NE 68803 <br />Lien Serla! umh4/ <br />oAOrlginall <br />Lien Type <br />Continuation QCorrected <br />Date of Lien <br />07/12/2003 <br />County <br />Hall <br />00411, . <br />00p3amom <br />ADDRESS <br />atlYiMAO -it0 <br />TAXPAYER NAME AND NAILING ADDRESS <br />a003 /003 <br />N9 sec of Elate - Dec LR <br />9=3286726 -5 <br />HQUGH MIA M <br />Filed: 07/22/2003 07:18 PM <br />20030-9468 <br />NOTICE OF STATE TAX LIEN <br />PLEASE DO NOT WRITE IN THIS SPAC <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 Fled With <br />Social Security Number <br />Spouse's Social Security Number <br />8390754 <br />] Register of Deeds <br />[] County Clerk <br />50611 7433 <br />Tax Period <br />Lien Serla! umh4/ <br />oAOrlginall <br />Lien Type <br />Continuation QCorrected <br />Date of Lien <br />07/12/2003 <br />County <br />Hall <br />BUSINESS NAME AND LOCATION <br />ADDRESS <br />Number <br />TAXPAYER NAME AND NAILING ADDRESS <br />Business Name <br />Name <br />Assessment Due <br />Mia M Hough <br />Street Address <br />Street or Other Mailing Address <br />120 East Third Street <br />city State Zip Code <br />city <br />State ZIP Code <br />Grand lslanri <br />nit= aaon-i <br />Tax <br />Category <br />Tax Period <br />Date of <br />Amount of Tax <br />Penalty <br />Interest <br />Addltlons <br />Balance of <br />Number <br />Assessment <br />Assessment Due <br />/U'I UY <br />UylLU- <br />01 /U1 8/2003 Uz. 07/12/2003 2,973.31 320.12 147.06 3,440.49 <br />21 0710112002 1213112002 07/12/2003 699.01 118.37 38.74 856.12 <br />21 01/01/2003 07/12/2003 1 14.17 -0- 137 115.54 <br />02/08/2003 <br />TOTAL $ 4,412.15 <br />hereby certify that the Nebraska Department of Revenue has complied with the revenue laws of the State of Nebraska in the <br />determination of the amount shown to be due, and the taxpayer has fallad to pay the amount due after demand. If this Notice of State <br />Tax Lien is an a ensi n of Off live r n, it serves to oontinue the priority of the state's interest in the affected property of the taxpayer. <br />Revenue _Senior Agent /� 308 385 -6073 <br />Sign Preparer's Signature Tite Date Telephone Number <br />here Revenue Supervisor <br />u oriz d n u e Title Da <br />4-494 -1974 Rev. 2-2002 SUpemeder 4.494 -1974 Rev. 10 -1595 <br />'1 <br />NS <br />V <br />