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02/18/2005 16:08 FAX 14024714429 <br />1� <br />c <br />NEBRASKA <br />200501459 <br />STL <br />01:02 PM <br />NOTICE OF STATE TAX LIEN <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 />9232419 77- 0605830 <br />Lien Serial Number Lien Filed With Social Security Number Spouse's Social Security Number <br />I <br />TOTAL $ 2,037.04 <br />1 hereby certify that the Nebraska Department of Revenue has complied with the revenue laws of the State of Nebraska in the 1 ;" <br />determination of the amount shown to be due, and the taxpayer has falled to pay the amount due after demand. If this Notice of State <br />Tax Lien is fn extension of an effective lie , it serves to continue the priority of the state's interest in the affected property Y of the taxpayer.(--,/ <br />� sign � Revenue Senior Agent d `l�_ dS 402 471 -5727 <br />9 Prepar gnatu Title Date <br />Telephone Number <br />here Revenue Senior Agent <br />Authorized Signature Title Date <br />4-494 -1974 Rev. 2-2002 Supersedes 4-494-1974 Rev. 10.1995 <br />XQ Register of Deeds <br />[] County Clerk 508 -08 -1740 <br />Date of Lien <br />Lien Type <br />County <br />02/13/2005 <br />Qx Original E] Continuation 0 Corrected HAIL <br />BUSINESS NAME AND LOCATION ADDRESS <br />TAXPAYER NAME AND MAILING ADDRESS <br />Business Name <br />Name <br />BRANDEN R. LEMBURG <br />Street Address <br />Street or Other Mailing Address <br />PO BOX 1601 <br />,jty <br />State Zip Code <br />City State <br />Zip Code <br />Tax <br />GRAND ISLAND NE <br />68802 <br />Category Tax Period <br />Number <br />Date of Amount of Tax <br />Assessment <br />Penalty Interest Additions <br />Balance of <br />7/1/04 THRU <br />01 <br />Assessment C <br />12/31/2004 <br />02/13/2005 1,682.11 <br />330.00 24.93 <br />2,037.04 <br />I <br />TOTAL $ 2,037.04 <br />1 hereby certify that the Nebraska Department of Revenue has complied with the revenue laws of the State of Nebraska in the 1 ;" <br />determination of the amount shown to be due, and the taxpayer has falled to pay the amount due after demand. If this Notice of State <br />Tax Lien is fn extension of an effective lie , it serves to continue the priority of the state's interest in the affected property Y of the taxpayer.(--,/ <br />� sign � Revenue Senior Agent d `l�_ dS 402 471 -5727 <br />9 Prepar gnatu Title Date <br />Telephone Number <br />here Revenue Senior Agent <br />Authorized Signature Title Date <br />4-494 -1974 Rev. 2-2002 Supersedes 4-494-1974 Rev. 10.1995 <br />