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11/O1/2011 TUE 14:45 FAX 402 471 4429 UCC SECRETARY OF STATE �� Hall � � , �116 ARNDT Filed: I�oo2�ooa STL /2011 09:28 fiM f � �� ! � �� . �.�'tr.--z-- Nebraska Departmerit of R��]�� NOTICE OF STATE TAX LIEN www.re.ven:ye.ne_gav This Notice of State Tax Lien is issued by the Nebraska Department 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 taupayer specified below and remain unpaid after demand. These taxes constitute a lien in the county for reai and personal property belonging to the taxpayer or hereafter ac uired. Nebraska Iden6fiqtion Num r Federal Idenbfication Number 98673831 Lien Serial Number Lien Filed With Social Security Numbet Spouse's Social S 11164298 [X]Register of Deeds �County Clerk XXX-XX-5190 Date of Lien Lien Type County 10/28/2011 �Original �Continuation �Corrected HALL BUSINESS NAME AND LOCATION ADDRESS TAXPAYER NAME AND MAILING ADDRESS MARK T ARNDT PO BOX 18 ALDA NE 68810 Category Tax Period Dats oF Amount of Tax Penalty Number Assessmeot 22 2005 01/14/2009 523.00 26.15 Interest Additions Balance of Assessment Due 180.01 729.16 I I I ` I TOTAL I$ �2s.is l I hereby certity that the Nebraska Departrnent of Revenue has complied with ihe revenue laws of the State of Nebraska in the determinaCwn of Ihe 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 effediye lien, it serv �o con6nue�riority of the state's interest in the affected property of the taxpayer. ' � Revenue Agent � (402)471-5789 sign Preparers ' nature e t Telephone Number here ► . eve�ue Supervisor f� . ��1� Auth rized ignature Title Date 4494-1974 Rev. 2•2062 Supersedes 4-494-1974 Rev. 70-1995 �