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01/17/2008 THU 15:10 FAX 402 471 4429 UCC SECRETARY OF STATE ~~~ Hall idJ004/004 '\0 \J 200800440, nebraska department of revenue Notice of State..Tax Lien Ir PLEASE 00 NOT WRITE IN THIS SPACE INDIVIDUAL INCOME TAX SOC. SEC. NO. NEBR. IOENT. NO. . SPOUSEgOC . SEC. NO. TAXABLE YEAR LIEN NO. COUNTY DATE OF NOTICE DATE OF ASSESSMENT #X...KX~778 45717516 2006 072500090 HALL 09/07/2007 05/16/2007 NICHOLAS 0 FAULK 1612 BYRON DR SOUTH BEND IN 46614 THIS NOTICE OF STATE TAX LIEN IS ISSUED BY THE NEBRASKA DEPARTMENT OF REVENUE FOR. INDIVIDUAL INCOME TAX' PURSUANT TO THE REVENUE LAWS OF THE STATE OF NEBRASKA. NOTICE IS HEREBY GIVEN THAT INDIVIDUAL INCOME TAXES INCLUDING PENALTIES AND INTERE~TI WHICH ARE SHOWN BELOW ARE DUE FROM THE ~TAXPAYER SPECIFIED ABOVE AND REMAIN UNPAID AFTER DEMAND. ' THESE .TAXES CONSTITUTE A LIEN IN THE COUNTY FOR PROPERTY BELONGING TO THE TAXPAYER OR HEREAFTER ACQUIRED. ' . AMOUNT OF TAX . . . . . . . . . . . . 658. 00 PENALTY . .' . . . . . . . . . . . .'. 32.90 INTEREST (COMPUTED TO 09/07/2007) . . . 20.91 UNDERPAYMENT OF ESTIMATED TAX PENALTY . 0.00 TOTAL AMOUNT DUE . . . . . . . . . . . 711.81, 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 SHOWN TO BE DUEl AND THE TAXPAYER HAS FAILED TO PAY THE AMOUNT DUE AFTER DEMAND. IF THIS NOTICE OF STATE TAX LIEN IS AN EXTENSION OF AN EFFECTIVE LIEN IT SERVES TO CONTINUE THE PRIORITY OF THE STATE'S INTEREST IN THE AFFECTED PROPERTY OF THE TAXPAYER. J do . : r II. f) II . d. ... . . /I' ('fo;l;) .. .d.\<<VV.~..... ~~ ~..... Jjt~/OK/.. .'f7/~J1 PREPARER'S S;;~RE/ TITLE , DATE/TELEPHONE .~-~ '~ SUf//4~/~....... 1.-lif.t:1~........... y~iiEb ~~NATURE TITLE DATE. . . ~