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<br />07/11/2008 FRI 15:09 FAX 402 471 4429 UCC SECRETARY OF STATE ~~~ Hall <br /> <br />121002/002 <br /> <br />0'0 <br /> <br />Please forward to: <br />Nebraska Dept of Revenue <br />4500 Ave I PO Box 1500 <br />Scottsbluff, NE 69363-1500 <br /> <br />200806007 <br /> <br />""1111'" <br /> <br /> <br /> <br />9908565477-4 Pas. 1 <br />SORTINO SHANNON III . <br />FlIed: 07/11/200801:21 PM <br /> <br /> <br />~, <br />N.ebr.....k.I' DlltIf4l;_M"'" <br /> <br />REVENUE <br /> <br />w....w.".w...u...:......aa~ <br /> <br />NOTICE OF STATE TAX LIEN <br /> <br /> PLEASE DO NOT WRITE IN THIS SPACE <br />This Notice of State T~x Lien is Issued by the Nebraska Department of <br />Revenue for unpaid taxes pursuant to the revenue laws of the state of <br />Nebraska. Notice is hereby given that taxes including penalties 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 /> 43379664 <br />Lien Serial Number Lien Filed With Social Security Number Spouse's Social Security Number <br /> 73470072 [&jRegister of Deeds o County Clerk XXX-XX-1302 <br />Date of Lien Lien Type County <br />07/09/2008 f&!Original DContinuatlon o COrrected Hall <br />BUSINESS NAME AND LOCATION ADDRESS TAXPAYER NAME AND MAILING ADDRESS <br />Business Name Name <br /> Shannon M Sortino <br />Street Address Street or Other Mailing Address <br /> 323 Redwood Road <br />City ~tate 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 />22 2006 08/31/2007 335.00 67.00 33.11 435.11 <br /> TOTAL $ 435.11 <br /> <br />I hereby certify that the Nebraska Department of Revenue has compIled With the revenue laws of the State of Nebraska In the determination of the <br />amount shown to be , and the laxp er 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 serv 0 continue the iority of the state's interest in the affected property of the taxpayer. <br /> <br />sign <br />here <br /> <br /> <br />Revenue Agent <br />Tille <br />Revenue Senior Agent <br />Title <br /> <br />07/09/2008 <br />Date <br /> <br />308632-1200 <br />Telephone Number <br /> <br />07/09/2008 <br /> <br />Date <br />4-494-1974 Rev. 2-2002 Supen,;ed". 4-.494-1974 R"v. 10.1995 <br /> <br />~ <br />