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03/24/2010 gTED 15:21 FAX 402 471 4429 UCC SECRETARY pF STATS ~~~ Hall o° Please forward to: Nebraska Department of Revenue 4500 Ave 1 Pa Box 1800 Scottsbluff, NE 69363-1500 201001957 X002/004 ~..hn a 0elo -UCC 5TL 981®622882-8 Pgs: 1 HILL KEVIN D Filed: Q3/2~1/201p 08:28 RM Nr3bre,ska Department of RE~N~IE NOTICE OF STATE TAX LIEN wvvw, c'eve. n u e, n e.g ov This Notice of State Tax Lien is issued by the Nebraska I~partment of Revenue for unpaid taxes pursuant to the revenue laws of the state of Nebraska. Notice is hereby given that taxes including penalties and interest, which are shown below, are due from the taxpayer specified below and remain unpaid after demand. These taxes constitute a lien in the county for real and personal property belonging to the taxpayer or herrrafter ac wired. Nebraska denti cation Number ederal IdentiAcatlon um r 37780581 Lien Serial Number Lfen pled Wi 5oclal ecunty umber Spouse's Sodas Secunty Number 11037469 ®Registerof pestle ~Counry Cleric XXX-XX-6687 pate of Lien Lien YP® County 03/22/2010 ®l7[iginal QContinuation ~Gorrected HALL . BUSINESS NAME AND LOCATIDN ADDRESS ~ TAXPAYER NAME AND MAILING ADDRESS KEVIN D HILL 1524 COVENTRY LANE APT 84 GRAND ISLAND NE 68801 Category Tax Perind Date. of Amount of Tax Penalty Interest Addltians Balance of Number Assessment Assessment Due 22 2008 05/25/2007 442.01 58.45 197.49 697.95 TOTAL $ 697.95 I hereby certify that the Nebraska pepartment of Revenue has complied with the revenue taws of the State a Nebraska m e delerminatron at the amount stx-wn to be and the lazy r has failed to pay the amount due aRer demand. If this Notice of State Tax Lien Is an extension of an effective lien, it serv s anti ue th ' rity t the state's interest In the affected property of the taxpayer. ^ Revenue Agent 03/22/2010 (308)632-1206 SIg11 a Si nature rile pate ale a Num r here ^ Revenue Su ervisor 03/22/2010 rite gnature Title Oate H8~18T~ Rev.2.2002 Supersedes ~-X91.78TH Rev. 10.1885