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07/26/2005 09:42 FAX 14024714429 NEBRASKA UCC 1?1003 /003 Please rctum to: STATE OF NEBRASKA DEPARTMENT OF REVENUE 1811 WEST 2m ST STE 460 GRAND ISLAND NE 68803 i dog NI see oast... - uce srL 1111111111111111111 1 lilt 9905404696 -8 Pas: 1 KLINGINSMITH DENNETA M Filed: 07122/2005 04:24 PM 200507158 NOTICE OF STATE TAX LIEN PLEASE DO NOT WRITS 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 real and personal property belonging to the taxpayer or hereafter acquired. Nebraska Identification Number Federal Identification Number 9141480 Lien Serial, mbe► Lien Filed With Social Security Number Spouse's Social Security Number 7 -3 ? El Register of Deeds County Clerk 508 -12 -0722 Date of Lien Lien Type County 07/200005 M Original E] Continuation Corrected Hall BUSINESS NAME AND LOCATION ADDRESS TAXPAYER NAME AND MAICING"ADDRES-S Business Name Name Denneta M Klinginsmith Street Address Street or Other Mailing Address 1612 W. Hagge Road City State Zip Code City State Zip Code Grand Island NE 68801 Tax 02/01/2005- 04/19/2005 630.78 63.08 12.13 20.00 725.99 Category Tax period I Date of I Amount of Tax I Penalty I Interest I Additions I Balance of I Number 03/01/2005- Assessment Assessment Due 01 02/01/2005- 04/19/2005 630.78 63.08 12.13 20.00 725.99 02/29/2005 03/01/2005- 01 07/13/2005 739.67 73.97 10.46 824.10 03/31/2005 04/01/2005- 01 04/30/2005 07/13/2005 726.97 72.70 6.69 806.36 05/01/2005- 01 07/13/2005 873.12 87.31 3.59 964.02 05/31/2005 TOTAL $ 3,320.47 1 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 taxpayer has failed to pay the amount due after demand. If this Notice of State 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. C>�Q - Revenue Senior Agent 308 385 -6073 sign Prepareyis Signatur6 Title Date Telephone Number here Revenue Supervisor - _ //0 Authoriz Si Ono Title Da 4 -494 -1974 Rev. 2 -2002 Supersades 4.494 -1974 Rev. 10-1995 /