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Tax <br />Category <br />Tax Period <br />Date of <br />Amount of Tax <br />Penally <br />Interest <br />Additions <br />Balance of <br />Number <br />Assessment <br />_ <br />Assessment Due <br />Jan. 10. 2014 3:24PM NE Secretary of State — UCC No. 2784 P. 5/6 <br />o� <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 />res a ideritihcfition Number <br />11302208 <br />Lien Serial Rumber <br />Date of Lien <br />12./18/2013 <br />I BUSINESS NAME AND LOCATION ADDRESS <br />Business Name <br />City <br />set Address <br />01 <br />I hereby certify that the Nobles <a Deparfnent o� <br />amount shown to be due, and the taxpayer has <br />effective Ilan, r se9tae continue the piio <br />sign <br />here <br />01 04101/20 11116/2013 <br />06/30/2012 <br />Lien FNed With <br />IN Register of Deeds 0County Clerk <br />Gen Type <br />IN Original ®Continuation <br />;brow wr ern v <br />REVENUE NOTICE OF STATE TAX LIEN <br />state Zip Cade <br />100.00 <br />201400174 <br />Federal identification Number <br />45- 522457 <br />Social Security Number <br />XXX. XX -6383 <br />County <br />9Corrected HALL <br />TAXPAYER NAME AND MAILING ADDRESS <br />Nadia <br />ELSA NIETO <br />SSeet or Other Malloy Address <br />1769 E. DANIELLA 17R <br />City <br />Q UEEN CREEK <br />35.00 <br />5.14 <br />NE UN of iksle Jahn Alisle - UC[ ET(. I. <br />I l <br />9914128744 -1 PBS: i <br />NIETO ELSA <br />Filed: 01r1er2e14 i1;57 nit <br />PLEASE DO NOT WRITE IN THIS SPACE <br />late <br />AZ <br />Spouse's Social Security Number <br />Zip Code <br />85140 <br />07/01 /2012 <br />09/30/2012 <br />11/16/2013 <br />100.00 <br />35.00 <br />3.68 <br />140.14 <br />138 86 <br />$ 279.02 <br />TOTAL <br />R evenue list compiled with the revenue laws of the State ofNebraske in the determination of the <br />led to pay the amount due after demand. If this Notice of Stale Tax Lien Is an extension of en <br />e state interest in the affected proper of the taxpayer. <br />Revenue Agent df „2'p! 402 471-5067 <br />Title 'Telephone Number <br />Revenue Senior Agent —1 7 .- <br />Title Date <br />4.84 -1974 new. 4-2002 Supereece9 4784 - 1971 AIM 10-1985 <br />