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<br />01/03/2008 ~HU 14:54 FAX 402 471 4429 UCC SECRE~ARY OF S~A~E ~~~ Hall <br /> <br />1210021003 <br /> <br />~ <br /> <br />Please return to; <br />STATE OF NEBRASKA <br />DEPARTMENT OF REVENUE <br />1811 WEST 2ND ST STE 460 <br />GRAND ISLAND NE 68803 <br /> <br />1~11l11111rrl <br /> <br /> <br />9908540890-1 Pgs; 1 <br />CORRRSAN INC. <br />Filed: 01/03/200801,10 PM <br /> <br />'200800069 <br /> <br /> <br />-.-""I;. .. _' ._ <br />~ -'- ---- <br />N'.b,.~".' O'~"r1_n\ .,,1' <br /> <br />REVENUE <br /> <br />www.r."'."u..'.....Q_. <br /> <br />NOTICE OF STATE TAX LIEN <br /> <br /> PLEASE DO NOT WRITE IN THIS SPACE <br />This Notice of State Tax Lienis issued by the Nebraska Department of <br />Revenue for unpaid taxes pursuant to the revenue laws of th'e state of <br />Nebraska. .NQticels hereby given that tax~s .including pena1tles and . <br />interest, which are shown below, are due from.the taxpayer specified <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 /> , . <br /> 9893873 . , <br />Lien Serial Number' Lien Filed With DCounty' Clerk I Social Security Number Spouse's SoclalSecurity Number <br />n..2, (() >< I nOD V 00 Register of Deeds <br />Date of lien Lief Type County <br /> 12/31/2007 OOoriginal' DContinuation ' DCorrel;ted " Hall <br />BUSINESS NAME AND LOCATION ADDRESS TAXPAYER NAME AND MAILING ADDRESS <br />Business Name Name <br /> Corrasan, Inc. <br />Street Address Street or other Mailing Address <br /> 1710 West 2nd Street <br />City :jtate Zip Code City State Zip Code <br /> Grand Island NE 68803 <br />Tax <br />. Category Tax Period Date of Amount of Tax Penalty Interest. Additions . Balance of <br />Number Assessment Assessment, Due <br />01 06/01/2007. 12/21/2007 8,255.89 825.60 136.84 9,218:33 <br />11/30/2007 <br />21 12/01/2006 05/11/2007 21.72 2.16 23.88 <br />12/30/2006 <br />21 01/01/2007 12/28/2007 1,769.65 442.42 65.53 21277.60 <br />06/30/2007 <br /> -...,.., <br /> .... <br /> . <br /> TOTAL $ 11,519.81 <br />I hereb certi that the Nebraska De artrrient of .Revenuehas com lied with the revenue laws of the Slale of Nebraska in the determination of the <br /> <br />y fy p p <br />amount shown to be due, and the texpayer has failed to pay the amount due after demand. If this Notice of State Tax Lien is an extension of an <br />effective lien, it serves to contin the priority of the state's interest in the affected property of the taxpayer. <br /> <br />. .' ... ~ -. Revenue Senior Agent //.:1./ :2./JAI <br />sign repare $ Sign r TiUe Date . <br />here <br /> <br />308 385-6073 <br /> <br /> <br />Revenue Supervisor <br />Tille <br /> <br />Telephone Number <br /> <br />~{1I;gno( <br />l)6te <br />4-494-1974 Rev. 2.2002 Supenedes4-494.1974 Rev. 10-1995 <br /> <br />~ <br />