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07/22/2005 10:00 FAX 14024714429 NEBRASKA UCC IM004 <br />Ir <br />i4 k& <br />Of Mks" <br />Please return to: <br />STA'L'E OF NEBRASKA <br />DEPARTMENT Off' REVENUE <br />1811 WEST 21'1D ST STE 460 <br />GRAND ISLAND NE 68803 <br />N! See of Sielu - UCC STL <br />i <br />i <br />9905494329 -1 Pas: 1 i <br />REGIS, INC <br />Filed: 07/31/2005 11:21 AM <br />200506995 <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 ac aired. <br />Nebraska Identification Number Federal Identification Number <br />9120726 71- 0924021 <br />Lien Serial Number Lien Filed With Social Security Number Spouse's Social Security Number <br />0.5 30 E Register of Deeds []County( <br />Date of Lien Lien Type County <br />07/18/2045 QX Original [j Continuation Corrected Hall <br />BUSINESS NAME AND LOCATION - ADDRESS - - -- - TAXPAYER'NAME AND- MAILING- ADDRES5 <br />Business Name I Name <br />AEGIS, INC <br />Street Address Street or Other Mailing Address•• <br />1004 N Diers Ave, Suite 300 <br />City State Zip Code City Stale Zip Code <br />Grand Island NE 68803 <br />Tax <br />Category <br />Tax Period <br />Date of <br />Amount of Tax <br />Penalty <br />Interest <br />Additions <br />Balance of <br />Number <br />Assessment <br />Assessment Due <br />21 10/01/2004- 02/11/2005 669.85 33.49 19.00 722.34 <br />12/31/2004 <br />21 01/01/2005- 05/12/2005 1,184.22 59.21 15.37 1,258.80 <br />03/3112005 <br />TOTAL $ 1,981.14 <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 extension of an effective lien, it serves to continue the priority of the state's Interest in the affected property of the taxpayer. <br />7 308 385 -6073 <br />Revenue Senior Agent Y1191 � <br />Sign preparer' Si nature Title Date Telephone Number <br />here _Revenue Supervisor _ D` <br />Title <br />4A94.1974 Rev- 2 -2002 Supersedes 4 -494 -1974 Rrv, 10.1995 P <br />