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_ Q Notice of State Tax Lien ~r nebraska ~9-~ i s 0 r~ V O tlepartment U11 • Reatl iltstructions on reverse side t. Lien Serial Number County Dat¢ Social Security Number - r 4/03!192 Hall _ _ 508-42-3252 Nebraska I.D. Number Lien Type Lien Fil¢tl With Spouse's So<iel Security Original ~ Register of Deetls Number 21-24787.14 ~ Renewal ~] county Clerk BUSINESS NAME AND LOCATION ADDRESS 7AXPAV ER NAME AND MAILING ADDRESS Business Name Name Blue RibboD Contracting, Inc. Hal Joaquin Prowett Street Atltlress ~ Street or Other Mailing Atltlress 3231 Ramada Plaza 2306 West Peralta Cliy Stafe Zip Code City State Zip Cotle Graad Islaad NE 68801 Mesa AZ 85202 Pursuant to the revenue laws of the State of Nebraska, notice is hereby given that taxes (inducing penalties, interest and additions) have been assessed and are due from the above taxpayer and remain unpaid after demand. These taxes constitute a Tien upon property in the county belonging to the taxpayer or hereafter acquired. Liens for roles and use taxes only attach to [he real property of the taxpayer located within the county or hereafter acquired. Tax Category Number Tax Period Date of ~~~ Amount of Tax Penalry Intareat Additiolts 8apttce of AtsassmeM DI>~ 4/1/76 thru 8. 31.43 102.08 772.51 ~ 7/1/76 thru 52.74 _ _ TO7AL I$ 825.30 1 hereby L¢rtity thdt the Nebraska Depdrtment Of Revenue hds Cpm plietl with the revenue laws of the State Of Nebraska In [he peter urination of the impunt Shawn to tin tlue, and the taxpayer has failEp to pay iris amount Oue after pemantl. It this Notice of State Tax lien is bn exlenaipn pt an 2ft¢t[iye i'tEn it SEry¢a tp tpnt:n~e the pfipr:ty of the $tate'S Intef¢St :n !ne at£ectep prCDe>t)' pt the tax 0..Yer. ~n ~ecial Ageat 3/29/79 ~~~~ Authorrietl Sigh Title Date FOR COUNTY OFFICIAL'S t~E L