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04/15/2009 WED 12:24 FAX 402 471 4429 UCC SECRE~ARY OF S~A~E ~~~ Hall 1aI003/009 & 200902823 1111111"111111U 99l/l9593499-6 Pus; 1 DERBY TERRY Filed: 04/16/2009 09:00 AM Please forward to: Nebraska Department of Revenue .4500 Ave I PO Box 1500 Scottsbluff, NE 69363-1500 IIr Notice of State Tax Lien Ilebraska departmellt or r(lllellue.. __ PLEASE DO NOT WRITE IN THIS SPACE soc. SEC. NO. NEBR. IDENT. NO. SPOUSE SOC. SEC. NO. TAXABLE YEAR LIEN NO. COUNTY DATE OF NOTICE DATE OF ASSESSMENT IND~VIDUAL INCOME TAX 508560190 38344513 2005 062090165 HALL 07/28/2006 'i /I z./ 2.001::. TERRY DERBY 518 E CAPITAL 38 GRAND ISLAND NE 68803 THIS NOTICE OF STATE TAX LIEN IS ISSUED BY THE NEBRASKA DEPARTMENT OF REVENUE FOR INDIVIDUAL INCOME TAX PURSUANT TO THE REVENUE LAWS OF THE STATE OF NEBRASKA. NOTICE IS HEREBY GIVEN THAT INDIVIDUAL INCOME TAXES INCLUDING PENALTIES AND INTEREST, ~ICH ARE SHOWN BELOW ARE DUE FROM THE TAXPAYER SPECIFIED ABOVE AND REMAIN UNPAID AFTER DEMAND. THESE TAXES CONSTITUTE ALIEN IN THE COUNTY FOR PROPERTY BELONGING TO THE TAXPAYER OR HEREAFTER ACQUIRED. AMOUNT OF TAX . . . . . . . . . . ;2:1.3, '13 PENAL TY . . . . . . . . . . . . . . . . . . 1 . 00 INTEREST (COMPUTED TO 4/;o/.MtJ9: . . . . b~.Db TOTAL AMOUNT DUE . . . . . . . . . ~.qf I HEREBY CERTIFY THAT THE NEBRASKA DEP~TMENT 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 FAILED TO PAY THE AMOUNT DUE AFTER DEMAND. IF THIS NOTICE OF STATE TAX LIEN IS AN EXTENSION OF AN EFFECTIVE LIEN IT SERVES TO CONTINUE THE PRIORITY OF THE STATE'S INTEREST IN THE AFFECTED PROPERTY OF THE TAXPAYER. E ~.4/......" ~~.. 'IJp/~~ . !19f )p??I?-dJ DATE/TELEPHONE .. ~~~? "d:.. ~T~ fOIOf