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yr LI E deer auqurrea. <br />Nebraska Identification Number <br />28806670 <br />Federal Identification Number <br />Lien Serial Number <br />11312962 <br />Lien Filed With <br />County Clerk <br />Social Security Number <br />XXX -XX -9599 <br />Spouse's Social Security Number <br />XXX -XX -7944 <br />3 <br />Register of Deeds 1 <br />Date of Lien <br />Lien Type <br />County <br />HALL <br />;3 <br />Original II Continuation II Corrected <br />, 01/08/2013 <br />BUSINESS NAME AND LOCATION ADDRESS <br />TAXPAYER <br />NAME AND MAILING ADDRESS <br />— <br />LINO A MENDEZ <br />RANDIE D MENDEZ <br />1405 N WALNUT <br />GRAND ISLAND NE 68801 <br />Tax <br />Category <br />Number <br />Tax Period <br />Date of <br />Assessment <br />Amount of Tax <br />Penalty <br />Interest <br />- <br />Additions <br />Balance of <br />Assessment Due <br />22 <br />2010 <br />05/18/2011 <br />1,209.84 <br />131.11 <br />121.13 <br />1,462.08 <br />22 <br />2011 <br />06/06/2012 <br />431.00 <br />24.05 <br />17.15 <br />472.20 <br />1 <br />TOTAL <br />$ 1,934.28 <br />I hereby certify that theile <br />amount shown to be e•' . , <br />e ent of Revenue has complied with the revenue laws of the State of Nebraska in the determination of the <br />'' ... er haft f.1lipr4 In nay Him ornA n.r .-i. flri., anT9nfl If thin r.u,ri..e ..f cro,s Too I re.. .e .... e.we....:.... ...., <br />01/14/2013 MON 15:31 FAX 402 471 4429 UCC SECRETARY OF STATE - -- Hall II002 /002 <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 />• <br />effective lien, it s <br />sign <br />here • <br />• znature • <br />:01300358 <br />NE Sec of Ste e John A eels - UCC S <br />9913706490 -4 Pgs: 1 <br />MENDEZ LINO A <br />Filed: 01/14/2013 12:40 PM <br />u <br />Nebraska Department of <br />REVENUE NOTICE OF STATE TAX LIEN <br />www.revenue.ne.gov <br />PLEASE DO NOT WRITE IN THIS SPACE <br />PLEASE RETURN TO: <br />NEBRASKA DEPT OF REVENUE <br />1313 FARNAM -ON THE -MALL <br />OMAHA NE 68102 -1871 <br />the : te's interest in the affected property of the taxpayer. <br />Revenue Agent r — ff " / 3 <br />Date <br />(308)632 -1210 <br />Telephone Number <br />/ -� <br />Tide <br />Revenue Supervisor <br />Title Date <br />4-494-1974 Rev. 2-2002 Supersedes 4 -494 -1974 Rev. 10-1995 <br />