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05!09/2001 15:25 FAX 14024714429 NEBRASKA UCC <br />oq <br />1Z 002,, 003 <br />j <br />NE.Wc "IIIti1111111111111111111111111 <br />1111111111 pgs <br />99@1140275 <br />CHAVEZ FIOEL M <br />Filed - 05/09/2001 02.22 PM <br />Notice of State Tax Lien <br />Or <br />MtMeaMe <br />esparvaant _ <br />I rwarwe <br />PLEASE DO NOT WRITE IN ThI1S SPACE <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 0 0 10 319 <br />Nebraska. Notice Is hereby given that taxes hicluding penalties and <br />interest, which are shown below, are due from the taxpayer speci$ed <br />below and remain unpaid alter demand. These taxes constitute alien In <br />the county for real and personal property belonging to the taxpayer or <br />hereafter acquired. <br />Nebraska Ider"cation Number Lien Fled With Social Security or Federal I.D. Number Spouses Social Security Number <br />_ <br />40306275 C7 ReglsOer a Deeds County Glen` 5 3 7- 2 9 -1 7 3 7 <br />Lien Serial Numbs Lien Type Date of lien County <br />010120241 ] Crigirw [] Con mnuation ❑ Corrected 03-23-01 HALL <br />BUSINE30 NAME AND LOCATION ADDRESS TAXPAYER NAME AND MAILING ADDRESS <br />Business Name Name <br />FIDEL M CHAVEZ <br />Street Address Street or Other Mailing Address <br />520 W LOUISE ST 1 <br />coy state Zip Code City State Zip Code <br />GRAND ISLAND NE 68801 <br />[late of Amount of Tax Penalty Interest Additions 1issis es of <br />C Tax Tax Period Asaesance f <br />NurnDDeer <br />22 1997 <br />11 -21 -00 193.00 9.65 51.061 253.71 <br />22 6998 11 -21 -00 172.00 8.60 29.99 210.59 <br />Please return to: <br />STATE OF'NEBRASKA <br />DEPARTMENT OF REVENUE <br />1811 WEST 211D ST STE 460 <br />GRAND ISLAND NE 68803 <br />TOTAL $ 464.30 <br />1 hereby certify that the Nebraska Department of Revenue ha8 compked with the revenue laws of the State of Nabraska in the detenNnation <br />of the amount shown to be due, and the taxpayer has failed to pay the amount due after demand. If this Nofioe of Stata Tax Lien is an extension of <br />an ant a Tian, t serves tD cons a the priority of the stete'a interest In the a property of the taxpayer. r <br />r r / tK <br />sign <br />here s s i rtne ( Telephone No. <br />se tai. DoA <br />14Miod ne a Ne <br />NEBRASKA DEPART NT aF R UE - WhRe and Goldenrod Copies TAXPAYER •Pink Copy NCO COUNTY OFFICE 74y sSS C� <br />awns a, ,.ywd acs <br />