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07/19/2012 THU 15:03 FAX 402 471 4429 UCC SECRETARY OF STATE -+-+y aall <br />fd10o3/007 <br />� <br />� <br />OROZCO <br />Flled: <br />a seta - ucc st� <br />P9s: 1 <br />08:69 AM <br />At�brislw �ppar�'ler�kff'+3 od <br />�'���E NOTICE OF STATE TAX LIEN <br />.�,.�„�.,.,..:,�.. �..,� � <br />PLEASE DO NOT WRITE IN THIS SPACE <br />This Notice of State Tax Lien is issued by the Nebraska Department of <br />Revenue for unpald taxes pursuant to the revenue laws of the state of <br />Nebraska. Notice is hereby gtven 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 lien <br />in the county for real and personal property belonging to the taxpayer <br />or hereafter acauired. <br />8887144 <br />' �� �Register of Deeds �County Clerk XXX-XX <br />Lien Type Counry <br />07/18/2012 QOriginal �Continuation �Corraded Hall <br />BUSINESS NAME AND LOCATION ADDRESS TAXPAYER NAME AND MAILING ADDRESS <br />Category Tax Period Date of <br />Numb�r Assessment <br />2 � 01/01/2011 08/10I2011 <br />03/31 /2011 <br />201205935 <br />Amount of Tax <br />55.68 <br />� <br />RAFAEL OROZCO <br />t or Other Mailing A dress <br />2105 N. NASHVILLE <br />State <br />GRAND ISLAND NE. <br />Penalty Interest Additions <br />8.35 I 3.42 <br />68803 <br />Balance of <br />�essment Due <br />67.45 <br />TOTAL I $ 67.45 <br />amount shown to be <br />effective lien, � se <br />sign e rep <br />here e �,, <br />the taacpayer <br />nue the prior <br />� <br />. � � -- i i j: <br />venue has comphed with the revenue laws of the State of Nebraska in the determination of the <br />d to pay the amount due after demand. If this Notice of State Tax Uen is an extension of an <br />state's interest in the affected property of the taxpayer. <br />"... Revenue Agent 7/z a � � Z� 402 471 � <br />Title Date Telephone Number <br />�'`- Senior Revenue Agent �- /�• /Z � <br />Tdle Date <br />A.194-1974 Rev.2-2002 Supersedes4-494�1974 Rev.10-1995 <br />i <br />s <br />i: - <br />