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<br />10/24/2008 FRI 13:49 FAX 402 471 4429 UCC SECRETARY OF STATE ~~~ Hall <br /> <br />1iI002/003 <br /> <br />Please forward to: <br />Nebraska Dept of Revenue <br />4500 Ave I PO Box 1500 <br />Scottsbluff, NE 69363~1500 <br /> <br />IIllIIIlrll11111 <br /> <br />F~IEDRICHSEN WILLIAM M Sli' 1 <br />Flled, 10/24/2a08 01:46 P" <br /> <br />\P <br /> <br />200808985 <br /> <br /> <br />~- <br />N.ebr.$k.- D.......r\nWorrt of <br />,REVENUE <br /> <br />WWW.FaIV.............GI!l.v <br /> <br />NOTICE OF STATE TAX LIEN <br /> <br /> PLEASE DO NOT WRITE IN THIS SPACE <br />ThiS Notice of State Tax 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 /> 98653008 <br />Lien Serial Number Lien Flied With rOCial Security Number Ispouse's Social Security Number <br /> 81440093 I!I Register of Deeds o County Clerk XXX-XX-4023 <br />Date of Lien Lien Type County <br />10/22/2008 1!I0riginal DContinuation o Corrected Hall <br />BUSINESS NAME AND LOCATION ADDRESS TAXPAYER NAME AND MAILING ADDRESS <br />Business Name Name <br /> William M Friedrichsen <br />Street Address Street or Other Mailing Address <br /> 818 W 3rd Street <br />City ~tate Zip Code City State Zip Code <br /> Grand Island NE 68801 <br />Tax <br />Category Tax Period Date of Amount of Tax Penalty Interest Additions Balance of <br />Number Assessment Assessment Due <br />22 2005 01/28/2008 2,798.28 164.71 589.79 3,552.78 <br /> TOTAL $ 3,552.78 <br /> <br />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 <br />amount shown to be , and the taxpa 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 to contin e the iorily of the state's interest in the affected property of lhe taxpayer. <br /> <br />sign <br />here <br /> <br /> <br />Revenue Agent <br />Title <br /> <br />Revenue Supervisor <br />Title <br /> <br />10/22/2008 <br />Date <br /> <br />308632-1200 <br />Telephone Number <br /> <br />1 0/22/2008 <br />Date <br />449'1-1974 R8V.2.2002 Supersedes 4-494.1974 Rev. 10-1995 <br /> <br />\/ <br />