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07/19/2012 THU 15:04 FAX 402 471 4429 UCC SECRETARY OF STATE -�yy 8a11 <br />� <br />i� <br />20120593 <br />�006/007 <br />NE Sec of S�� <br />991269597 <br />OROZCO RAFAEL <br />Flled: �7/19/2012 08:59 RM <br />81i�bwackit O�Spa.nr.svr2oe <br />�E�1� NOTICE OF STATE TAX LIEN <br />*�vwa+.s�vrrw.o�...f. aoa. <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 is hereby given 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 />9528717 <br />Category <br />Number <br />o� <br />01 <br />�,j � QRegister of Deeds �County Clerk XXX <br />Lien Type ounry <br />07/1$/2012 QX Original �ContinuaGon �Corrected Hall <br />BUSINESS NAME AND LOCATION ADDRESS TAXPAYER NAME AND MAILING ADDRESS <br />Tax Period � Date of <br />09/30/2011 04/02/2012 <br />10/01 /2011 03/12/2012 <br />12/31/2011 <br />Amount of Tax <br />529.34 <br />122.85 <br />Rafael Orozco <br />t or Other Mailing Address <br />2105 N. Nashville <br />State <br />Grand Island Ne. <br />Penalty Interest Additions <br />25.00 23,84 <br />25.00 3.03 <br />68803 <br />Balance ot <br />:essment Due <br />578.18 <br />150.88 <br />TOTAL � $ 729.06 <br />amount shown to be due, and the taxpayer <br />effective lien, it serv continue the pri � <br />sign e Prep rers Signature <br />here e <br />orized Signatur <br />r nevenue nas compnea wrcn me revenue �aws ot tne 5tate of Nebraska in the determina�ion of the — <br />failad to pay the amount due after demand. If this Notice of State Tax Lien is an e�dension of an <br />'tha state's interest in the affected property of the taxpayer. <br />�" Revenue Agent 7� d� ,�v/Z 402 471-6067 <br />Tdle Date Telephone Number <br />�i Senior Revenue Agent 7 � . �� <br />Title Daie <br />4�794-1974 Rev. 2-2002 Suparsedes 4�94-1974 Rev. 10-7995 <br />