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<br />02/12/2008 TUE 15:23 FAX 402 471 4429 UCC SECRETARY OF STATE ~~~ Hall
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<br />1210021002
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<br />Dlb
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<br />Please return to:
<br />ST ATE OF NEBRASKA
<br />DEPARTMENT OF REVENUE
<br />1811 WEST 2ND 8T 8TE 460
<br />GRAND ISLAND NE 68803
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<br />$TL
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<br />20.0801151
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<br />990a5477Z7-3 Pss: 1
<br />LEMBURG WARREN
<br />Filed: 0211212008 02:17 PM
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<br />N..."'ni..k. O_.r1,,,,,,,"rn 04
<br />REVEN:UE
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<br />NOTICE OF STATE TAX LIEN
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<br /> PLEASE DO NOT WRITE IN THIS SPACE ,
<br />This Notice of State Tax Lieni~ ,issued by the Nebraska Department of
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<br />'Revenue for unpaid taxes pursuant to the revenue laws of the state of
<br />Nebra$ka~ ,Notice is hereby given that taxes including 'penalties and
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<br />..interest, which are shown below, are due from~heJaxpayer specified
<br />below and remain unpaid after demand. Thes~ taxes, constitute a lien
<br />In the county for real and personalJ>roperty ~elonglrig to the taxpayer
<br />or hereafter acquired~' '
<br />'Nebraska Ide':ltiflcation .Number " Federal Identification Number
<br /> 9809111 20-4841372
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<br />Lien Se~al NU~R{ Lien Filed With:' Social Security Number Spouse's Social Security Number
<br />, ,o6lo' ' 0')(':> I!IRegister ofDe,ed~ :OCounty Clerk " XXX-XX-7442
<br />Da,te of Lien .' LI~n }"ype , County ,
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<br /> 02/08/2008 OOOriginai, ,Dcontlnllation " . " D~9rr89ted, , . , Hall , ,
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<br /> ,'BUSINESS.NAME AND LOCATION ADDRESS' ' , , . :' r::'TAXPAYERNAMEAIIIDMAlpNGADDRESS . ,
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<br />Business Name' Name " ,
<br /> '"' '" Warren Lemburg
<br />Street;Address ' . " Street or Other Mailing Address
<br /> , 5137, N 190thRoad
<br />Clo/, ~tate Zip Code-; , City Stale Zip Code
<br /> Cairo , NE 68824
<br /> Tax ' , ,
<br />, Category Tax Period Date, of Amount of rax " Penalty Interest Additions Balance of
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<br />" Number Assessment Assessment Due
<br /> 01 07/01/2007~, 02/0512.0.08 1.497.,8.0 34.77 1,532.57
<br /> .09130/2.007
<br /> 01 10/0112007- 02/05/2008 258.96 " 25.90 4.28 289.14
<br /> 10/31/2.007
<br />. ' '21 04/.0112007 01/22/2.008 464,94 116.24 19.58 ' 60.0.76
<br /> 06/30/2.0.07
<br /> 21 .0710112007- 01/22/2008 204.78 3.0.71 4.50 239.99
<br /> 09/30/2.007
<br /> 21 101.01/20.07- 01/23/2.008 47.93, 2.4.0 0.09 50.42
<br /> '; 10/24/2007 " , ,-,
<br /> " TOTA'- $ 2,712.88
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<br />I hereby certifY that the Nebraska Department of'Revenue'has compiled with lhe revenIJe Ja\(VS ofthl;l State of,Nebraska 10 the'deterrrii,natioJ:'! of the
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<br />amount shown tq be due, and the taxpayer has failed to pay the amount due after'demand. If this Notice of $tateTax Lien is ~n extension of an
<br />~ffective lien, it serves to continue ttie priority of the state's interest In the affected property of the taxpayer.
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<br />,- .' ... ~~ Q4.1.stf;;J , Revenue Seni~r Ag'ent , .02/.08/2008
<br />61g n Prepare, s ignatu e " " Title ' , Dale
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<br />here Revenue Supervisor
<br />Title '
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<br />'308 385-6.073
<br />Telephone Number
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<br />021.08/2008
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<br />Date
<br />4-494-1974 Rev. 2,2002 Supersedes 4-494-'974 Rev, 10-1995
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