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07/22/2005 10:00 FAX 14024714429 NEBRASKA UCC Q003 <br />L9 �, <br />Please retum to: <br />STATE OF NEBRASKA <br />DEPARTMENT OF REVENUE <br />1811 WEST 2N ST STE 460 <br />GRAND ISLAND NE 68803 <br />Or <br />00110" <br />NS Sec of siefe - UCC STL <br />i <br />i <br />I <br />9906404328 -9 Pas: 1 <br />D.H.S. BUILDERS INC. <br />Filed; 07/21/2016 11:21 AM <br />200506994 <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 Federal Idenlificatinn Number <br />8792232 1 47- 0845272 <br />Lien Serial Number Lien Filed With Social Security Number Spouse's Social Security Number <br />05 O-7 Z3,23 X❑ Register of Deeds County Clerk <br />Date of Lien Lien Type County <br />07/18/2005 []x Original ❑ Continuation Corrected H811 <br />BUSINESS NAME AND LOCATION ADDRESS TAXPAYER NAME AND' MAILING ADDRESS <br />Business Name Name <br />D.H.S. BUILDERS, INC. <br />Street Address Street or Other Mailing Address <br />1004 Diers Ave, Suite 300 <br />City Stale Zip Code City State zip Code <br />Grand Island NE 68803 <br />Category I Tax Period I Date of I Amount of Tax <br />Number Assessment <br />21 10 0 31/2004 1 02/11/2005 I 3,449.28 <br />Penalty interest I Additions I Balance of <br />339.99 1 225.62 1 1 4,014.89 <br />TOTAL $ 4,014.89 <br />1 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 failed to pay the amount due after demand. If this Notice of State <br />Tax Lien is an exte sion Pf an ¢f- fective lien, it serves to continue the priority of the state's interest in the,affected property of the taxpayer. <br />- �Y^ R e v e <br />enu Senior A cant 308 385 073 <br />sign Preparer's <br />here <br />Title Date Ze h ne Number <br />Revenue Supervisor _ 4 <br />Title <br />4 -49 4 -1974 Rev, 7 -2002 Supersedes 4-094-1974 Rev, 10-1895 _ / <br />