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10/17/2012 WED 15:08 FPilt 402 471 4429 UCC SECRETARY OF 5TATE ~~~ 6a11 <br />_� <br />� <br />' <br />2012Q�691 <br />�J003/004 <br />NE Sec e <br />991270 <br />MEDINR mIR VRRGpS <br />Flled: 10l17/2012 09:42 Flpl <br />Ev.i,b*ssk■ �Lfs,ga�rt�rnee+t ae <br />#'�E1���� NOTICE OF STATE TAX LIEN <br />W VvW�.s�Vrn.Ci.t+�.Od'v <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 lian <br />in the county for real and pe�sonal property belonging to the taxpayer <br />or hereafter acauired. <br />10847464 <br />�� d�/ 9 d 3 �X Register of Deeds �County <br />.ien Lien Type <br />10/12/2012 []X Original []Continuation <br />BUSINESS NAME AND LOCATION ADDRESS <br />Category Tax Period Date of <br />Numbe� Assessment <br />Q � 07/01/2011 11/02/2011 <br />07/31 /2011 <br />01 02/01 /2011 08/13/2012 <br />Q2/28l2011 <br />01 06/01 /2011 08J 13/2012 <br />06/30/2011 <br />01 08/01 /2011 08/13I2012 <br />08/31 /2011 <br />Amount of Tax <br />0.00 <br />225.00 <br />225.00 <br />58.00 <br />XXX-XX-8355 <br />�Corrected Hall <br />TAXPAYER NAME A MAi LING ADDRESS <br />� <br />Edia Vargas Medina <br />t or Other Mailing Address <br />108 W. 9th St. <br />State Zip Code <br />Grand Island Ne. 68801 <br />Penalty interest Add(tions Balance of <br />13.23 0.70 <br />47.50 17.48 <br />47.50 13.72 <br />30.80 3.04 <br />13.93 <br />289.98 <br />286.22 <br />91.84 <br />TOTAL I $ 681.97 <br />I hereby certify that the Nebraska DepartmeM ot Reve�ue has compfietl with the revenue laws or cne a[a[e or neQrasKa �m m� uC�G�������auu�� v� ���o <br />amount shown to be due, and the taxpayer has failed to pay the amount due after demand. If this Nodce of State Tax Lien is an extension of an <br />effective Gen, it serve continue the priori he state's interest in the affected property of the taxpayer. <br />e � 402 471-6067 <br />� �,� Revenue Agent /o s o ' <br />sign repar r's Signature Title Date Telephone Number <br />here e Senior Revenue Agent !�- /S- �? <br />horized Signature. Title Date <br />. A�94-1974 Rav. 2•2�2 Snpereades A-0847974 Rev. 10-1985 <br />Y� <br />� <br />