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This Notice of State Tax Lien is issued by the Nebraska Revenue for unpaid taxes pursuant to the revenue laws Nebraska. Notice is hereby given that taxes including penalties interest, which are shown below, are due from the taxpayer below and remain unpaid after demand. These taxes constitute in the county for real and personal property belonging or hereafter acquired. Department of of the state of and specified a lien to the taxpayer PLEASE DO NOT WRITE IN THIS SPACE Nebraska Identification Number 98138235 Federal Identification Number Lien Serial Number 11313984 Lien Filed With County Clerk Social Security Number XXX -XX -9329 Spouse's Social Security Number 3 Register of Deeds 1 Date of Lien 01/15/2013 Len Type County HALL t ,74 Original • Continuation II Corrected BUSINESS NAME AND LOCATION ADDRESS TAXPAYER NAME AND MAILING ADDRESS ARACELY VAZQUEZ PO BOX 521 GRAND ISLAND NE 68802 Tax Category Number Tax Period Date of Assessment Amount of Tax Penalty Interest Additions Balance of Assessment Due 22 2007 08/21/2010 155.00 7.75 40.17 202.92 22 2008 03/13/2010 653.00 32.65 122.55 808.20 TOTAL $ 1,011.12 I hereby certify that the Nebraska Department of Revenue has comolied with the revenue laws of the State of Nebraska in the determination of the 01/17/2013 THU 14:39 FAX 402 471 4429 UCC SECRETARY OF STATE amount shown to be due, and the taxoayer has failed to pay the amount due after demand. If this Notice of State Tax Lien is an extension of an effective lien, i serves to continue the priority of the state's interest in the affected property of the taxpayer. Nebraska Department of Signature REVENUE NOTICE OF STATE TAX LIEN www.revenue.ne.g ► e/ • J • Revenue Agent j� /L—.:20(3 s • r epay- ` ignature / itle Date here • Revenue Supervisor Title 20130044) Hall 991370 -1 Pss: 1 VAZOUEZ RRRCELY Filed: 0111712013 10:43 RM (402)471 -6043 Telephone Number Date 4- 494-1974 Rev. 2-2002 Supersedes 4- 494 -1974 Rev. 10-1995 12 002/002 • • • I