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09/14/2007 FRI 15: 28 FAX 402 471 .4429' UCC SECR.ii'ARY OF STATE ......... Hall & 'Ill" . r l'1~br~5k~ dO~l1n\cn1 Clf rovon ~o HE 58., ..f 1~8'. Jail" A ,",I.. - lICe $T~ 100707982' 121005/005 PLEASE DO 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 frQm 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 8785082 Lien Serial Number Lien Filed With Social Security Number Spouse's Social Security Number J 200'1 () :J'Iq , [!] Register of Deeds D County Clerk 505-78-7536 Date or Lien Lien Type County 09/12/2007 o Original 0 Continu~tion D Corrected Hall I BUSINESS NAME AND LOCATION ADDRESS TAXPAYER NAME AND MAILING ADDRESS I Business Name Name CYNTHIA S BOND , Street Address Street or Other Mailing Address PO BOX 104 l?ity State Zip Code City state Zip Code ALDA, NE 68810 I Tax -1 Category Tax Period Date of Amount of Tax ' Penalty Interest ' Additions Balance of Number Assessment Assessment Due 01 1/1/06 THRU 07/03/2007 825.47 133.10 61.15 1.019.72 12/31/2006 ' TOTAL $ 1,019.72 9907525582-7 Pgs: 1 aONO CYNTHIA S 'Filed: 0911412007 10:50 AM NOTICE OF STATE TAX LIEN 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 s~own to be due, and the taxpayer has failed to pay the amount due after' demand. If this Notice of State Tax Lien is a xtension or a ffe' lien '1 serves to continue the priority of the state's int~res.t ~ the affected property of the taxpayer. .... Revenue Senior Agent 9//;2./01 402 471-5709 sign Title Date TelePt'fle ~mber here .... Revenue Senior Agent CJ,//cJ,jO'l Title Date ""'-"" .... """" "'............. ,,,,.... '~'ij?