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03/23/2005 16:44 FAX 14024714429 Or nebraska department of revenue NEBRASKA UCC 200502539 Q004/004 :26 Am Notice of State Tax Lien PLEASE DO NOT WRITE IN THIS SPACE INDIVIDUAL INCOME TAX SOC. SEC. NO. 505352562 NEBR. IDENT. NO. 39059553 SPOUSE SOC. SEC. NO. TAXABLE YEAR 1997 LIEN NO. 043380071 COUNTY HALL FLORENCIO A CAYAX -DATE -OE-NOT-ICE.- _ __..- 12/- 03/0.0_4 - - -_ --928--S--LOCUST-ST - DATE OF ASSESSMENT 10/07/2004 GRAND ISLAND NE 68801 THIS NOTICE OF STATE TAX LIEN IS ISSUED BY THE NEBRASKA DEPARTMENT OF REVENUE FOR INDIVIDUAL INCOME TAX PURSUANT TO THE REVENUE LAWS OF THE STATE OF NEBRASKA. NOTICE IS HEREBY GIVEN THAT INDIVIDUAL INCOME TAXES INCLUDING PENALTIES AND INTEREST, WHICH ARE SHOWN BELOW ARE DUE FROM THE TAXPAYER SPECIFIED ABOVE AND REMAIN UNPAID AFTER DEMAND_ THESE TAXES CONSTITUTE A LIEN IN THE COUNTY FOR PROPERTY BELONGING TO THE TAXPAYER OR HEREAFTER ACQUIRED. AMOUNT OF TAX . . . . . . . . . . . . . . . . . . 1,135.00 PENALTY . . . . . . . . . . . . . . . . . . . . . 283.75 INTEREST (COMPUTED TO 12/03/2004) . . . . . . . . 612.80 TOTAL'AMOUNT DUE . . . . . . . . . . . . . . . . 2,031.55 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 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 NTEREST IN THE AFFECTED PROPERTY OF THE TAXPAYER. _ .... . � "� r �.� .4 n / ........... 3 7/5 35 .�5. / .��........ . PREPARER'S SIQNATU TITLE DATE /TELEPHONE. AUTHOR .ED SIGNATURE TITLE .• DATE. Ud rms Toros