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01/17/2008 THU 15:09 FAX 402 471 4429 UCC SECRETARY OF STATE ~~~ Hall 121003/004 ~ca 200800439 11'111" 'III r If I " 9908543760-9 PSlI: 1 BIRctI ANTHONY L Fiied, 01/17/2008 02:46 P" :~ :N..b'''III.k..llliOlpil!l,,*-~ ~# REVENUE 'w....w.i1'.""..h_.1...rIIo.'iliIiOv' NOTICE OF STATE TAX LIEN 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 from 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 ac uired. Nebraska Identification Number Federal Identification Number 32034083 'Uen Serial Number Lien Filed With Social Security Number 00 Register of Deeds o County Clerk XXX-XX-8349 Lien Type 01116/2008 00 Original DContinuation BUSINESS NAME AND LOCATION ADDRESS Business Name 070820128 Spouse's Social Security Number XXX-XX-0785 ate of Lien County o Corrected HALL TAXPAYER NAME AND MAILING ADDRESS Name ANTHONY L & THERESA R BIRCH Street Address Street or Other Mailing Address 830 N NORTH RD City ae Zip Code City State Zip Code GRAND ISLAND NE 68803 ax Category Tax Period Date of Amount of Tax Penalty Interest Additions Balance of Number Assessment Assessment Due 22 2003 08/05/2006 776.50 352.00 297.72 1,426.22 22 2004 08/05/2006 172.00 43.00 32.03 247.03 22 2005 12/06/2006 534.00 26.70 67.24 627.94 sign here TOTAL $ 2,301.19 partment of Revenue has complied with the revenue laws of the State of Nebraska In the determination of the payer has failed to pay the amount due after demand. If this Notice of Stale Tax Lien is an extension of an priori f the state's interest in the affected property of thf IB/P(~yerl.. 0 a' , L ~_ U 402471-5835 Title Date. Telephone Number G4<;rl-t' 4r""L.;vr /-(6 -t)A I1lJe . Date 4-494-1974 Rev. 2-2002 Supersedes 4-494-1974 Rev. 10-1995 (1)