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08/05/2010 THU 14:13 FAX 402 471 4429 UCC SSCRBTARY OF 51<'AT13 way Hall <br /> <br />201005534 <br />Please forward to: <br />Nebraska Department of Revenue <br />4500 Ave I PQ Box 1500 <br />Scottsbluff, NE 693b3-1500 <br />X005/005 <br />NIL Sec of 54x4• Jehn p Gele _ ACC ST4, <br />8910633971-® <br />FRIESEN TODD pes: 1 <br />Filed: 08/06/2010 72;45 PI7 <br />Nebraska pepartment of <br />REVENUE NOTICE OF STATE TAX LIEN <br />www.revenub-rte.Dov <br />11042583 ®Register of peels County Clark XXX-XX-5717 XXX-XX-9294 <br />pate o ien Lien Type County <br />08/02/2010 ®t7riginalContinuation Corrected HALL <br />BUSINESS NAME AND LOCATIQN ADDRESS TAXPAYER NAME AND MAILINf; ADDRESS <br />TODD FRIESEN <br />LORI FRIESEN <br />4134 W FAl17LEY AVE <br />GRAND ISLAND NE 68803 <br />This Notice of State Tax Lfen is issued by the Nebraska Department of <br />Revenue for unpaid taxes pursuant to the revenue Taws 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 Aen <br />in the county for real and personal property belonging to tha taxpayer <br />or hereafter ac uired. <br />Nebraska Idenb lcation Number ederal Identificatie <br />30102774 <br />lien Sepal Number lien Frled 1t $pgal <br />Category Tax Period Date of Amount of Tax penalnr Irrterest Addltians Balance of <br />Number Assessment Assessment Due <br />22 2007 03111 /2009 632.00 156.40 86.14 874.54 <br />h <br />TOTAL $ 874.54 <br />I hereby certify that the Ne raska epartment of Revenue has complied with the revenue laws of the State p Nebraska in the determination of the ' <br />amount shown to bed nd the taxpay s failed to pay the amount due after demand. If this Notice of Slate Tax Lien is an extension of an <br />effective lien, ii serve continu the of estate's interest in the affected property of the taxpa~e <br />^ ` Revenue Agent ~~ (308)632-1206 <br />sign s pat Title pate elephon umb <br />here ^ Revenue su ervisor ~i <br />' ature Title p - <br />4.494-1874 Rav. 2-2002 SlIpslSedes 4494-197 Rer. 10.1885 <br />rV <br />