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<br />03/31/2009 TUE 14:53 FAX 402 471 4429 UCC SECRETARY OF STATE ~~~ Hall <br /> <br />121002/004 <br /> <br />\jCCJ <br /> <br />200902347 <br /> <br />11111111111\11111 <br /> <br />9909591791-4 PliIS. 1 <br />~H~~:~i7i~~g0g9 09:31 AM <br /> <br />Please forward to: <br />Nebraska Department of Revenue <br />4500 Ave I PO Box 1500 <br />Scottsbluff, NE 69363-1500 <br /> <br /> <br />..~ <br />Ne:~.I'.!lill:~'.o~I:J~rtlll~.~ ot <br />RIM., ' '. g., I- <br />. "... "j <br />. .. .. JJ. <br />',"Iii' w ~'~~\i~n'~.;.' 'e'~ '.V <br /> <br />kl~:-'" .. ."f' '''S' ta;i.- T: '. .. ,.- . , <br />..u.8e 'B '>,:'" :;Lt; ,ax J;;;;1,eft <br /> <br />. 'P'l.~AgE:~ :JiiOf'WRITE IN r;:lISSflACE <br /> <br />L <br /> <br />. . <br />. .... '.' . '-. ": ".' ~ 001..1..' .... . <br /> <br />.', - '".' <br />". , <br /> <br />. !iND'tlt~,)ML ~ _~il.~<m~~ <br />- . . . <br /> <br />.... ,".', , <br /> <br /> <br />..~:~~~;~: NG~ <br /> <br />;TA$BLE Y~~R" <br />L:I E1<f ~NO. <br />'COUNT'Y <br />lJATEO:F NOTICE <br />. 'I>A'lJE OF ASSESSMENT. <br /> <br />~~J~i_ " <br /> <br /> <br />. """ ()4:..T...". . <br />. ..1'>.*_'-.:','- <br /> <br />08;26iQ~g.7 .' . <br />H:A'Ll1 <br />09/19/20,08 ' <br />07/03/2:QG8 <br /> <br />. ',c'-' <br /> <br />Eml,J;;i:'~N~ ,:C ..:QEYES . <br />. 7'();9E"gma s\r <br />"Gf{hND 'ISLAND' NE 6:8:201' <br /> <br />!::~i:~~~~~rrJ!!=![~Ef=:ts:!W~ <br /> <br />''t;AXES 11\lCLUDING PEN.ALT.'lES. ~NP:' 'rN$!~~E's-'l'I.,'WH:rCH ARE'SHOWN',:B$!iOW -A1t!;PUE <br />';::~:ET;~X:~~~~~'I~:~iliI'~~E:~~E\T:r~=~i~.~g:~~~~:i~g=::~~t;, TO <br /> <br />,'tH$'TAXPAYER bR l'IEREA'FT~R'A6~tlI~)!:O. <br />AMOUNT OF TAX . . . . . . . . ~.' . . . . . . 382.00 <br />PENALTY . . . . . .. . ']" . . .. . . . . .. 19.10 <br />INtEREST (COMPUTE.I> TO 3/d:~/e2(1)9"" 't.. . .. . .. 101.90 <br />UNDERPAYMENT OF ESTIMATED TAX t".t!;ftALn. . . . . . 0.00 <br />TOTAL AMOUNT DUE .. . . . . . . . .'. .. . .. 506. (]I) <br />I HEREBY CERTIFY THAT THE NEBRA:SKA DEP'ARTMEN'TOF ~E,VENUE HAS' COMPLIED <br />WITH THE REVENUE LAWS OF THES~A'l'E OF NEBRASKA IN THEt>:ETERMIIqATION OF <br />THE AMOUNT SHOWN TO aE:nUE.I Mli THETAXPAYE:R :fIAS FAIL>>:D TbPAYTHE <br />AMOUNT DUE AFTER DEMAND.. I-F ':ratS 'NOTICE 9F STATE TAX LIEN IS AN <br />EXTENS NOE' ANFFEQ1.tVELl:EN' ITS.i:RVESWOGQNTINUE 'filE PRIORITY OF <br /> <br /> <br /> <br />R R IS' A~ T' '- (/ /I . DAT$lT~~E~ON1;: <br />.... .. ~,"" ,,,' :". ....... ..(/.~ .. ...~l:':!2f/~t..:. <br />Al:JTHOR.:J.!:D SlG.ATUR,ET_,T~~ , '. ,.' .' .,.1' ......, DAi4", <br /> <br /> <br />IITtS' 011107 <br /> <br />"...------"--~m--~"V " <br />