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09/10/2008 WED 14:11 FAX 402 471 4429 UCC SECRETARY OF STATE ~~~ Hall & Please forward to: Nebraska Dept of Revenue 4500 Ave I PO Box 1500 Scottspluff, NE 69363-1500 200807799 ,~ N...br...k. D".'""""nt ad' REVENUE VYw...... _ '-.\I'I!Io"ua<. ,"~_ GO....' 121002/002 ~.- "lll Illfl nIl 9908570512-7 Pgs, 1 GILLESPIE COREY D FLIed: 09/10/200S 02;10 PM 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 Nebra&kaoNotiee--is-flef'eby...given--that-taxeS--i-RGlud~ng-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 acauired. Nebraska Identification Number Federal Identification Number 99534851 Lien Serial Number Lien Flied With <Isoclal Security Number Spouse's Social Security Number 80040081 [&JRegister of Deeds DCounty Clerk XXX-XX-4533 Dat~. of lien Lien Type County 09/08/2008 00 Original DContinuation o Corrected Hall BUSINESS NAME AND LOCATION ADDRESS TAXPAYER NAME AND MAILING ADDRESS Business Name Name Corey D Gillespie Slreet Address Street or Other Mailing Address 1003 S Lincoln Avenue City ::itate Zip Code City Stale Zip Code Grand Island NE 68801 Tax. Category Tax Period Date of Amount of Tax Penalty Interest Additions Balance of Number Assessment Assessment Due 22 2005 09/14/2007 1,240.00 356.50 238.44 1,834.94 TOTAL $ 1,834.94 I hereby certIfy that the Nebraska Department of Revenue has complied WIth the revenue laws of the State of Nebraska 10 the determmatlon of the amount shown to be and the taxpay'er has failed to pay the amount due after demand. If this Notice of State Tax Lisn is an extension of an efte_ctive tien, it serv continue the rity of the state's interest in the affected property of the taxpayer. sign here Revenue Agent Tille Revenue Supervisor Tille 09/08/2008 Date 308632-1200 Telephone Number 09/08/2008 Date 4-494-1974 Rev_ 2-2002 SUp8I5edes 4-494-1974 Rev. 10-1995 v.