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Tax <br />? <br />- - - -- <br />Category <br />Tax Period <br />Date of <br />Amount of Tax <br />Penalty <br />Iptereltt <br />Additions <br />Balance of <br />Number <br />AC In/ Anna A <br />Assessment <br />.. �. ... <br />Assessment Due <br />03/19/2013 TUE 15:01 FAX 402 471 4429 UCC SECRETARY OF STATE <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 />or hereafter acquired. <br />Nebraska Identification Number <br />9662170 <br />Lien Serial Number <br />Date of Lien <br />// 7 <br />Business Name <br />Street Address <br />City <br />02/21/2013 <br />BUSINESS NAME AND LOCATION ADDRESS <br />01 <br />09/30/2011 vafu ucu ► i 11/02/2011 <br />01 <br />01 <br />Lien Filed With <br />Lien Type <br />State Zip Code <br />1K *beeski'J�payerf 0-0' <br />REVENUE <br />www.s irvs+,�+�r r.�. anov <br />0.00 <br />201302165 <br />Federal Identification <br />Register of Deeds (J County Clerk <br />Original Continuation ['Corrected <br />Name <br />109.64 <br />-0a-* <br />NOTIC OF STATE TAX LIEN <br />PEASE DO NOT WRITE IN THIS SPACE <br />Social SeOp <br />Hall <br />Nyltber <br />77629 <br />Hall <br />ALBERTO 41 A REYNA <br />Street or Olher Mailinj A r Si <br />PO BOX 581 <br />City r' <br />G R AND IS AND <br />Sec of S ate John A Cate - UCC ST <br />9913711032 -1 P9s: <br />LUNA REYNA ALBERTO <br />Filed: 03/19/2013 11:38 AM <br />NE <br />Spouse's Social Security Number <br />TAXPAYER I'AME AND MAILING ADDRESS <br />State <br />Iai003 /004 <br />Zip Code <br />10/01/2011 10/02/2012 <br />02/29/2012 <br />03/01/2012 <br />08/31/2012 <br />11/01/2012 <br />317.91 <br />1,480.32 <br />125.90 <br />317.50 <br />.4 t <br />here /ji 'di } L... Senior Revenue Agent <br />A thorized Signatur Title " ' Date <br />9Y 2 -2002 Supersedes 4-494-1974 Rev. 10-1995 <br />122.13 <br />679.26 <br />1,646.89 <br />$ 2,448.28 <br />I hereby certify that the Nebraska Department of Revenue has complied with the revenue laws pt the State` of Nebraska in the determination of the <br />amount shown to be due, and he taxpayer has failed to pay the amount due after demand. If thisNs !c of State Tax Lien is an extension of an <br />effective lien, it se• - s to continue the prior , • the state's interest in the affected property of the ta4 ere <br />8 �. 41 Revenue Agent <br />sign Preparers Signature p, Title <br />402 471 - 6067 <br />Telephone Number <br />