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09/18/2006 16:34 FAX 14024714429 NEBRASKA uee ~ 0021003 \ft. 8911114'71733-1 PSIS; 1 MOSTEK HERBERT LEE F!lad: 0911812008 12,00 PM Please return to: STATE OF NEBRASKA 'DEPARTMENT OF REVENUE 1811 WEST 2ND ST STE 460 GRAND ISLAND NE 68803 200608368 IIr NOTICE OF STATE TAX' LIEN I'Icbr&Slla lIOPIMlol'i4 oI~ PLEASE DO NOT WRITE IN THIS SPACE This Notice qf State Tax Lien Is iss,u~d ,~y 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 speci~ed , below and remain unpaid after demand. These taxes constitute a lien in the county for real and persomdproperty belonging to the taxpayer or, hereafter acauired. Nebraska Identification Number Federal Identification Number 9024824, . " ' . -- Lien Serial Number Lien Filed With Social Security Number Spouse's Social Security Number ~ (}11l1 nOJJ.F o Re~ister of Deeds o County Clerk 508-86-9302 Date of lien \ Lien Type County 08/0912006 t!I O~i~ln~1 tJ Co~t1nu~tion o Corrected Hall '. ' " r BUSINESS NAME AND LOCATION ADDRESS TAXPAYER NAME AND MAILING ADDRESS -I Business Name Name Herbert lee Mostek Slreet Address Street or Olher Mailing Address 3618 Palamino Drive City State Zip Code City Slale Zip Code Grand Island NE 68803 I Tax I Category Tax Period Date of Amount of Tax Penalty Interest Add'ltions Balance of Number Assessment Assossment Due 01 10-01-2004- 05/05/2005 385.18 43.82 51.67 480.67 12/31/2004 01 01/01/2005- 07/22/2006 532.35 106.48 41.22 680.05 03/31/2005 01 04/01/2005- 07/22/2005 177 .45 42.74 11.08 231.27 04/30/2005 " . " ,. L-..... .. " TOTAL $ 1,391.99 , ,-- sign here I hereby certify that the Nebraska Department of Revenue has complied with the revenue laws of lhe Stale of Nebraska in the delermination of the amount shown to be due, and the taxpayer has failed 10 pay the amount due after demand. If this Notice of Slate Tax Lien is an extension of an ffective lien, II serves to continue the priori1y of the state's intereslln the affected property of the taxpayer. , Revenue Senior Agent RJq J.:l tJ~ 10 308 385-6073 TiUe Date . Revenue Supervisor Title . Ie 4-494-1974 Rev. 2-2002 Superoedas 4--494-1974 Rev. ,o-199f'=Jp ;t.