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08/27/2008 WED 14:30 FAX 402 471 4429 UCC SECRETARY OF STATE ~~~ Hall 121004/004 ~ 200807443 SCON 9908569463-9 Pgs : BOEHLE BRIRN K Filed: 08/27/2008 10:23 RM .~ N.,b.....kll,D""'''''nlWent as iREVE.. N. iU: E r . r ~ '~\I.""",",'. lie.",,.. "'ii;... t...'(ji a...' 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 aCQuired. Nebraska Identification Number Federal Identification Number 36441953 Lien Serial Number Lien Filed With Social Security Number Spouse's Social Security Number 980160018 00 Register of Deeds Dcounty Clerk XXX-XX~5950 Date of Lien Lien Type County 01/16/1998 Doriginal [&/Continuation o Corrected HALL BUSINESS NAME AND LOCATION ADDRESS TAXPAYER NAME AND MAILING ADDRESS Business Name Name BRIAN K BOEHLE Street Address Street or Other Mailing Address 1325 WOOD MOOR DRIVE City ~tate Zip Code City State Zip Code MONUMENT CO 80132 Tax Category Tax Period Date of Amount of Tax Penalty Interest Additions Balance of Number Assessment Assessment Due 22 1994 12/01/1997 526.17 26.31 130.65 683.13 TOTAL $ 683.13 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 due, and the taxpayer has tailed to pay the amount due after demand. If this Notice of State Tax Lien is an extension of an effective lien, it serves to tinue the 'orily of the state's interest in the affected property of the taxpayer. ~ Date sign here 402 471-5928 Telephone Number 5dA!.. .8 -Zz. ~(j ~ Date 4-494-1974 Rev. 2-2002 Supersedes 4-494-1974 Rav. 10-1995 cf