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071'24/2003 15:39 FAX 1.4024714429 NEBRASKA UCC Z002/002 NS r.. •f 54.4• - LIcc rTL 200309659 Please return to: STATE OF IN'EBRASI{A FRY 4-7 peg: t ERM DEPARTMENT OF REVENUE Filed: 07/24/2008 12.47 PM 1811 WEST 2ND ST STE 460 GRAND ISLAND NE 68803 Ir NOTICE OF STATE TAX LIEN �aAratrii+ _ aaw�nmont or r6Y4MNtb 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 taxp er has failed to pay the amount due after demand, If this Notce of State Tax Lien is an xten for n off ctve lien, It serves to c nue th priori of the stat interest in the affected property of the taxpayer �. ~ 308 385 -6073 sign pa is igna a ite Date Telep ne N tuber here 0, 12X 'e-Ll Authorized re S' n Title QXte -494 -1974 Rev. 2.2002 S fersedee 4- 484 -1974 Rev. 12-1990 �MFy 1 M a 4 PLEASE 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 rea! and personal property belonging to the taxpayer or hereafter acquired. Nebraska Identification Number Lien Filed With Federal Idertification Number Social Security Number 6349900 X❑ Register of Deeds []C Cleric 505 88 5334 Lien Serial Nu er Lien Type QX Original Continuation 7 Corrected Cate of Lien 07116/2003 County Hall BUSINE 5 NAME AND LOCATION ADDRESS TAXPAYER NAME AND MAILING ADDRESS Business Name Name Erin K Fry Street Address Street or Other Mailing Address 1004 Dlers Ave, Suite 214 City State Zip Code City State Zip voce Grand Island NE 68803 Tax Category Tax Period Date of Amount of Tax Penalty Interest Additions Balance of Number Assessment / Assessment Due 01 01/01/2000 07/16/2003 19,659.40 3,971.11 3,091.30 0.00 25,721.81 03112/2003 21 04/01/2002 07/16/2003 514.98 89.91 25.05 0.00 629.94 12131/2.002 21 01101/2003 07/16/2003 250.00 -0- 4.44 0.00 254.44 03/12/2003 67 07101/1997 07/16/2003 266.00 152.00 66.58 0.00 484.58 06130/2002 TOTAL $ 28,090.77 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 taxp er has failed to pay the amount due after demand, If this Notce of State Tax Lien is an xten for n off ctve lien, It serves to c nue th priori of the stat interest in the affected property of the taxpayer �. ~ 308 385 -6073 sign pa is igna a ite Date Telep ne N tuber here 0, 12X 'e-Ll Authorized re S' n Title QXte -494 -1974 Rev. 2.2002 S fersedee 4- 484 -1974 Rev. 12-1990 �MFy 1 M a 4