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<br />04/19/2007 THU 15:39 FAX 402 471 4429 UCC SECRETARY OF STATE ~~~ Hall <br /> <br />~002/003 <br /> <br />200703176 <br /> <br />'111 "IIHlllr III ~I <br /> <br /> <br />9907505993-4 pg;: 1 <br />GOODRICI-I MARK 0 <br />Flled: 04/19/2007 10:37 AM <br /> <br />oen <br /> <br />Pleasf return tv; <br />ST ATE OF NEBRASKA <br />DEPARTMENT OF REVENUE <br />18 J J WEST 2ND ST STE 460 <br />GRAND ISLAND NE 68803 <br /> <br />IIr <br /> <br /> <br />NotiCE OF STATE TAX LIEN <br /> <br />ncbmllt <br />clopI,,",OIII <br />.",,,,- <br /> <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 />Interestr,whlch are shown below, are due from the taxpayer spe~lfled <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 acquired. <br />Nebraska Identification Number Federal Identification Number <br /> 9501223 ., <br /> ... <br />Lien Serial Number Lien Filed With Social:Security Number Spouse's Social Security Number <br />O~ 1f->11 ()n"?h ,. [!]Register of Deeds o County 'Ciern .".506087986 .. ... .. . ".. <br />O.aleof LIe., ". _..,~..". .-.. -- . Llen,Type. .. Counly <br /> 04/12/2007 . ~ Original 0 Conlinuaiion o Corrected .00"_- <br /> Hall <br />I BUSINESS NAME AND LOCATION ADDRESS TAXPAYER NAME AND MAILING ADDRESS I <br />Business Name Name <br /> Mark D Goodrich <br />Street Address Slreet or Other Mailing Address <br /> 2831 Wortman Ave. # 7 <br />City State Zip Code City State Zip Code <br /> Grand Island NE 68803 <br />I Tax I <br />Category Tax Period Date of Amount of Tax Penalty . Interest Additions Balance of <br />Number Assessment Assessment Due <br />01 04/01/2005- 04/12/2007 4,299.72 859.93 304.15 5,463.80 <br />09/30/2006 <br /> .. <br /> -- <br /> , ,.. <br /> ..". . . <br /> . . TOTAL $ 5,463.80 <br /> <br />I 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 amounl shown to be due, and the taxpayer has failed to pay the amount due after demand. If this Nolice of State <br />Tax Lien Is an extension of a ffect"ve lien, it serves to continue the priority of the slale's interest in the affected property of the taxpayer. <br /> <br />308 385-6073 <br /> <br /> <br />Revenue Senior Agent <br />Title <br /> <br />Revenue Supervisor <br />Title <br /> <br />04/18/2007 <br />Date <br /> <br />sign ... <br />here <br /> <br />Telephone Number <br /> <br />04/18/2007 <br /> <br />Dale <br />4494-1974 Rev, 2-2002 SUI*$1lCkIG 4-494-1974 Rev. 10..1995 <br /> <br />v....- <br />