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07/19/2012 THU 15:04 FAX 402 471 4429 UCC SECRETARY OF STATE ��� Hall <br />a <br />�` <br />�012�0�93� <br />f�oo�/oo� <br />� ce►e - ucc sn <br />P9s: 1 <br />�9:00� RM <br />t4�h�as�s �e�p�rtrreent �dA <br />�E�E�iI�� NOTICE OF STATE TAX LIEN <br />vrrww.x rrvr e.�r, nr.o ov <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 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 Ifen <br />in the county for real and personal properly belonging to the taxpayer <br />or hereafter acauired_ <br />9528717 <br />Category <br />Number <br />01 <br />01 <br />01 <br />01 <br />01 <br />i � QRegister of Deeds �County <br />Lien Type <br />07/18/2012 QOriginal �Continuadon <br />BUSINESS NAME AND LOCATION ADDRES5 <br />Tax Period � Date of <br />09/30/2009 01/01/2010 <br />01/01l2010 08/04/2010 <br />03/31 /2010 <br />10/01/2009 09/18/2010 <br />12/31/2009 <br />04/01/2010 03/07/2011 <br />09/30/2010 <br />10/01 /2010 08/04/2011 <br />03/31 /2011 <br />amount shown to be <br />effective lien, it se <br />sign e rep i <br />here e �,�, <br />Amount of Tax <br />0.00 <br />� �� <br />0.00 <br />0.00 <br />1,195.82 <br />XXX-XX-9472 <br />[]corrected Hall <br />TAXPAYER NAiNE AND WIAILING ADDREBS <br />Rafael Orozco <br />t or Other Mailing Address <br />2105 N. Nashville <br />Grand Island <br />Penalty Interest <br />0.00 24.93 <br />0.00 12.32 <br />153.00 78.58 <br />45.73 17.64 <br />125.08 84.82 <br />TOTAL <br />4ROZC0 <br />Filed: <br />Ne. 68803 <br />Additlons Balance ot <br />Assessment Due <br />24.93 <br />12.32 <br />231.58 <br />63.37 <br />1,405.72 <br />$ 1,737.92 <br />sna veparunen� oT rcevenue nas compueu wttn the revenue laws of the State of Nebraska in the determination of the <br />the taxpayer has f"led to pay the amount due after demand. If this Notice of State Tax Lien is an extension of an <br />bue the priori f e state's inlerest in the affected property of the taxpayer. <br />� � Revenue Agent 7`� ��/i 402 47 <br />�ture Title Date Telephone Number <br />�` Senior Revenue Agent , . . L <br />ature T�le Date <br />4-4J4-1974 Re¢ 2 2QD2 Supersedes 4434-1974 Rev. 70-1995 <br />i <br />