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This Notice of State Tax Lien is issued by the Nebraska Department of Revenue for unpaid taxes pursuant to the revenue laws of the state of Nebraska. Notice is hereby given that taxes including penalties and interest, which are shown below, are due from the taxpayer specified below and remain unpaid after demand. These taxes constitute a lien in the county for real and personal property belonging to the taxpayer or hereafter acquired. PLEASE DO NOT WRITE IN THIS SPACE Nebraska Identification Number 97509663 Federal Identification Number Lien Serial Number 11316228 Lien Tied With 3 Register of Deeds II County Clerk Social Security Number XXX - XX - 6149 Spouse's 'al Security Number Date of Lien 01/30/2013 Lien Type a Original 1 Continuation /Corrected County HALL BUSINESS NAME AND LOCATION ADDRESS TAXPAYER NAME AND MAILING ADDRESS PEDRO SANCHEZ 374 N CLARK GRAND ISLAND NE 68801 Tax Category Number Tax Period Date of Assessment Amount of Tax Penalty Interest Additions Balance of Assessment Due 22 2008 03/14/2010 327.00 16.35 61.50 404.85 TOTAL $ 404.85 I hereby cert'vi that the Nebraska Department of Revenue has mmeliM with the rArent IP !awe of the. carp r f nrphr eke in frInct ,aetar.,,:now,,., .4 t>,o 02/05/2013 TUE 14:52 FAX 402 471 4429 UCC SECRETARY OF STATE - -- Hall FI004 /005 amount s effective I sign here • due, and the to contin rized Signature Title Nebraska Department of Revenue Agent ervisor REVENUE NOTICE OF STATE TAX LIEN wwwrevenue s fail - • o pay the amount due after demand. If this Notice of State Tax Lien is an extension of an of the t- -': interest in the affected property of the r 1 - er. • (402)471 -5731 Telephone Number Date 4-494 -1974 Rev. 2-2002 Supersedes 4-494-1974 Rev. 10-1995 NE Sec of State John A Gale - UCC STL 9913708038 -8 Pys 1 SANCHEZ PEDRO Filed: 02/05/2013 12:14 PM