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10/18/2006 16:39 FAX 14024714429 NEBRASKA Dee fa! 0021002 \jlD Pll::lISe retum to: STATE OF NEBRASKA DEPARTMENT OF REVENUE J 8 J I WEST 2ND ST STE 460 GRAND ISLAND NE 68803 !-" 200609300 Ir NOTICE OF STATE TAX LIEN ~k' dopal1mt". 04"......oIl... _ PLEASE 09 NOT WRITE 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 co'nstltute a lien in the county for real and personal property belonging to the taxpayer or hereafter acquired. . Nebraska Identification Number Federal Identification Number 9213783 Lien serl~~;Jber Lien Filed With, 'Social Security Number Spouse's Social Secl,lrily NUlT)ber ...... ',f)Io( OO?YJ .' [~JRegister of Deeds. o County Cle.rk ',~~:~? ~i ... .. - Date of Lien Lien Type County : 10/17/2006 ' [!] Original'" tJ Continuation o Corrected Hall . '.~. . . - I BUSINESS NAME ANO LOCATION ADDRESS TAXPAYER NAME AND MAILING ADDRESS I Business Name Name . OPEN RANGE CONSTRUCTION. L. L. C. Street Address Street or Other Mailing Address P. O. Box 5472 City Slate - Zip Code City State Zip Code Grand Island NE 68802 I TalC I Category Tax Period Date of Amount of Tax Penalty Intere&t Additions Balance of Number Assessment . Assessment Due 02/01/2006- ' . 01 D6/0612006 09/30/2006 4',606.87 921 AD 114.77 5,643.04 . . ~..~ ".,~. ~~-~. '."' '. " ......, ' .'-.._,-,.. ,,- ,..- ,~. . - . TOTAL $ 5,643.04 sign here ~ I hereby certify'that the Nebraska Department of Revenue has complied wl\h 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 effective. lien, it selVes to continue the priority of the state's interest in the affected property of the taxpayer. , . Revenue Senior Agent I()j /7/ ,)/)t:Jb . 308 385-6073 .' Tille Dale. Telephone Number Revenue Supervisor /lJ!J 7/lJ.-b Title Dat6 / 4-'1614-1974 Rev. 2-2002 Supersedes 4-494--1974 Rev. 10-1995 0 . . n