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07/12/2012 THU 14:07 PAX 402 471 4429 UCC SECRETP,RY OF ST1�E -�y� eall � �� � 2012057 �k�abraski STfrpsaYFteae�Rfs� �� wwsrv.+r�sn�..: s. yrow �005/005 p Gate - UCC STL psg: , me:ss ar+ NOl"10E �F STATE TAX LIEN This Notice of State Tax L�en is issued by the Nebraska Department of Revenue for unpaid taxes pursuant to the revenue laws of the state of Nebraska. Notice Ps hereby given that taxes Including penalties and interest, which are shown below, are due from the taxpayer speclfied be{ow and remain unpaid after demand. Thes� taxes constitute a lien in the county for rea) and personal property belonging to the ta�cpayer or hereafter acauired. 9688862 �� p 7 QRegistarof Deeda �County � LEen Type 07/08/2012 []X Originai �Continuation []Corrected Hall BUSINESS NAME AND LOCATION ADDRESS TAXPAYER NAME AND MAILING ADDRFSS � Jesus Castaneda t or Othec Mailing Address 1116 W. Oklahoma State Grand Island Ne. Penalty Interest Additions Category Tax Pe�iod Date of Number Assessment �� 07/01/2010 11/03/2010 08i31/2010 01 10/01/2010 02/07/2Q11 11/30/2010 01 03/01 /2011 05/05/2011 03/31/2011 01 Q4�01/2011 12/18i2011 07/31/2011 01 08/01/2011 p1/03/2012 08/31/2011 Amount of Tax 439.56 0.00 11.95 2,430.00 57.82 20-3856452 XXX-XX-2333 64.39 38.70 33.78 2.65 25.00 0.72 495.00 124.67 25.00 2.27 TOTAL 688Q1 Balance of 534.65 36.43 37.67 3,049.67 85.09 $ 3,743.51 � nereoy cerury r,na� tae naoras�ca ueparunent or rcevenue rtas compuea wrtn tne revenue iaws or tne s[a[e or Ne�rasKe in me ae[ermmauon or me amount shown to be due, and the taxpayer hes failed to pay the amount due after demand. If this Notice of State Ta�c Lien is an entension of an effective lien, it serv ntinue the p'' o the state's interest in the afFected properly of the taxpay r. e ' Revenue Agent �/L o?d/ i._. 402 471-6067 sign re rer's Signature Title Date Telephone Number here � � �_i�-- Senior Revenue Agent 7- / f-/ 2--. uthorize igna re Tide Date 4-494-1974 Rev. 2-2�2 Superaedes 4-4941874 Rev. 1D-1895