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<br />02/11/2009 WED 11:44 FAX 402 471 4429 UCC SECRETARY OF STATE ~~~ Hall <br /> <br />12l002/003 <br /> <br />DB <br /> <br />, Please forward to: <br />Nebraska Department of Revenue <br />4500 Ave I PO Box 1500 <br />Scottsbluff, NE 69363-1500 <br /> <br />200900949 <br /> <br />;1111'I11II11Inl' l <br /> <br />9909586596-3 pgs: 1 <br />~T~~a7 ~~~~~/~009 09:45 RM <br /> <br /> <br />~. <br />iN\eb!r..~k.; Di!t\lI,",rh'noeont of' <br />iREVENiUE <br /> <br />wwW....,.IllU.."'..aBV <br /> <br />NOTICE OF STATE TAX LIEN <br /> <br /> PLEASE DO NOT WRITE IN THIS SPACE <br />This Notice of State Tali: Lien Is Issued by the Nebraska Department of <br />Rev.enue for unpaid taxes pursuantto the revenuelawsofthestate,of <br />. Nebraska. Notice is hereby 9hien thaf taxes"includlng penalties and' <br /> .. . <br /> . . <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 p~rsonal property belonging to the taxpayer <br />or hereafter acquired. <br />Nebraska Identification Number Federal Identification Number <br /> 43719724 <br />Lien Serial Number Lien Filed With Social Security Number Spouse's Social Security Number <br /> 83310004 00 Register of Deeds Dcounty Clerk XXX-XX-8777 <br />Dale of Lien Lien Type County <br /> 02/09/2009 I!IOriginal Dcontinuation o Corrected Hall <br /> BUSINESS NAME AND LOCATION ADDRESS TAXPAYER NAME AND MAILING ADDRESS <br />Business Name Name <br /> Sally S Wenzel <br />Street Address Street or Other Mailing Address <br /> 05 Navajo Drive <br />City -srare Zip Code City Stale 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 2003 07/06/2008 39,209.76 9.802.44 12,877.99 61,890.19 <br /> 22 2004 09/25/2008 1,465.00 366.25 393.27 2,224.52 <br /> 22 2005 09/1612008 23,763.86 5,940.97 4,953.30 34,658,13 <br />," <br /> TOTAL $ 98,772.84 <br /> <br />Ii'. <br /> <br />I hereby certify that the Nebraska Department of Revenue has compiled With the revenue laws of the State of Nebraska In the detemllnaUon of the <br />amount shown to be du nd the taxpayer s failed to pay the amount due after demand. If this Notice of State Tax Lien Is an extension of an <br />effective lien, it serves c inue e prio of t state's interest in the affected property of the taxpayer. <br /> <br />sign <br />here <br /> <br /> <br />Revenue Agent <br />Title <br /> <br />Revenue Supervisor <br />Title <br /> <br />02/09/2009 <br />Date <br /> <br />308632-1200 <br />Telephone Number <br /> <br />02/09/2009 <br /> <br />Date <br />4-494.1974 Rev. 2.2002 SUJl(lI1Iedes 4-494.1974 Rev. 10-1995 <br /> <br />09 <br />