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02/08/2012 WED 15:17 FAX 402 471 4429 UCC SECRETARY OF STATE ��� Hall <br />� �\ <br />20120102G <br />�II�'1 � � <br />�ooz�ooa <br />2 10:66 FlMl <br />�e�.�k� a�.,�,�. �� <br />����� NOTICE OF STATE TAX LIEN <br />www. r w+�e.n+wq.+w.owsw <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 i� hereby given that taxes including pe�alties and <br />interest, which are shown below� are due [rom 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 hereafte� acauired. <br />10776907 <br />Category <br />Number <br />0'i <br />01 <br />o� <br />01 <br />27-2807333 <br />0 � QRegister of Deeds �County Cle�c XXX-XX-7464 <br />Lien Type . Counry <br />02/02/2Q12 QOriginal �Continuation �Conected Hall <br />BUSINESS NAME AND LOCATION ADDRESS TAXPAYER NAME AND MAILING ADDRESS <br />Tax Period Date of <br />Assessment <br />09/01/2010 01/05/2011 <br />09/30/2010 <br />10/01 /2010 12/18/2011 <br />10/31/2010 <br />11/01/2010 12/1$/2011 <br />11/30/2010 <br />12/01 /2010 12/18l2011 <br />12/31/2010 <br />Amount of Tax <br />0.00 <br />230.00 <br />230.00 <br />230.00 <br />Ricardo Rodriguez <br />t or Olher Mailing Address <br />4006 Reed Rd <br />Grand Island <br />Penalty Interest <br />0.00 <br />48.00 <br />a8.00 <br />48.00 <br />1.09 <br />13.67 <br />12.73 <br />11.75 <br />1.09 <br />291.67 <br />290.73 <br />289.75 <br />TOTAL � $ 873.24 <br />i nereoy cerury mat me rveorasxa uepartmen[ or rcevenue nas compnea wtth tne revenue iaws ot tne state ot NeorasKa in me aecerm�nauon ot ma <br />amount shown to be du and the taxpayer has failed to pay the amount due after demand. If this Notice of Skate Tax Lien is an e�ctension of an <br />affective fien, it se s continue the p of the sjate's i�terest in the affer.ted property of the taxpaye . <br />8� Revenue Agent L�� 402 471-G067 <br />sign Prep rers 5ignature Trtle Da e Telephons Number <br />here e � Senior Revenue Agent 2_ (�, •/ L <br />thorized Signature Title Date ' <br />4-09A-1874 Rev.2•2002 Superaedas4494-1874 Rev,10-1995 <br />Ne. 68801 <br />Additions Balance of <br />Assessment Due <br />Y �. <br />