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This Notice of State Tax Lien is issued by the Nebraska <br />Revenue for unpaid taxes pursuant to the revenue laws <br />Nebraska. Notice Is hereby given that taxes Including penalties <br />interest, which are shown below, are due from the taxpayer <br />below and remain unpaid after demand. These taxes constitute <br />. In the county for real and personal property belonging <br />or hereafter acquired. <br />Department of <br />of the state of <br />and ' <br />specified <br />a lien <br />to the taxpayer <br />PLEASE DO NOT WRITE IN THIS <br />• <br />Nebraska Identification Number <br />43206352 <br />Federal Identification Number <br />Lien Serial Number <br />11326555 <br />Lien Filed win <br />3 Register of Deeds • County Clete <br />Soda) Security <br />XXX -XX -0705 <br />Spas S oddi Security Number <br />Date . = <br />12/12/2013 . . • <br />Type <br />(]Original ['Continuation ■ Corrected <br />County <br />HALL <br />BUSINESS NAME AND LOCA11ON ADDRESS <br />TAXPAYER NAPE AND MAILING ADDRESS <br />RAMON VERJAN PALACIOS <br />1414 ST PAUL RD APT 86 <br />GRAND ISLAND NE 68801 <br />Tax <br />Category <br />Number <br />— <br />Tax Period <br />- <br />Irate of <br />Assessment <br />Amount of Tax <br />_ <br />Penally <br />Interest <br />Additions <br />Balance of <br />Assessment Due <br />22 <br />2009 <br />08/04/2013 <br />12,010.73 <br />600.54 <br />1,972.06 <br />14,683,33 <br />22 <br />2010 , <br />06104/2013 <br />3,080.93 <br />• 154.05 <br />•351.62 <br />3,586.80 <br />TOTAL <br />$ 18,170.13 <br />1 hereby certify dial the Nebraska Department of Revenue has complied with the revenue laic( the Stele of Nebraska In the determination of the <br />amount shower to be due. end the believer has failed to rev the tumid' due after demand- if Ns NnIlCA d Snr#a Tex 1 ion is an avtansrrw ofd, <br />Dec.16. 2013 2:24PM NE Secretary of State — UCC <br />Mg vac of Si.ia Jahn M Gale • UCC a7L <br />1 111111 <br />II <br />9913727334 -9 Pus: 1 <br />PALACIOS RAMON VERJAN <br />Filed: 12/16/2013 01 :OB PM <br />No.2387 P. 2 <br />201309695 <br />PLEASE RETURN TO: <br />NEBRASKA DEPT OF REVENUE <br />PO BOX 94609 <br />LINCOLN NE 68509 -4609 <br />Nebraska.Department of <br />REVENUE NOTICE OF STATE TAX LIEN <br />www,ravenue.ne.Oov <br />etfeckve Hen, it serves to continue the <br />s <br />here ► <br />state's interest In the affected property of the taxpayer. <br />Revenue Agent /2—'3 —/ <br />Date <br />4191.1971 Raw 1Ua02 Sm enedee 4-401-1074 Rev. 101999 <br />