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03/30/2004 12:12 FAX 14024714429 NEBRASKA UCC 0 002/003 200403046 WON Poe: 2 51 AM NOTICE OF STATE TAX LIEN 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 ar_nuiraril I PLEASE DO NOT WRITE IN THIS SPACE Nebraska Identification Number 37479520 Lien Serial Number 951600019 lien Filed With [Social Security,Number QX Register of Deeds 0 County Clerk 456 -23 -7686 Lien Type _ _ Date of Lien [] Inal XO Continuation orrected 06/09/1995 Spouse's Social Security Number County HALL BUSINESS NAME AND LOCATIO DRESS TAXPAYER NAME AND MAILING ADDRESS Name JUAN M CALDERA Business Name Street Address Street or Other Mailing Address 611 E 11ST B City State Zip Code City State Zip Code GRAND ISLAND NE 6880/ Tax Category Number Tax Perlod Date of Assessment Amount of Tax Penalty Interest Additions Balance of Assessment Due 22 1991 04/18/1995 608.00 152.00 169.74 929.74 TOTAL $ 929.74 - -- - -- ...,r.... "'. -.. � ..�•cnuc naa winNucu wnn uro revenue caws oT the State of Nebraska In the determination of the amount shown to be due, and the taxpayer has failed to pay the amount due after demand. If this Notice of State Tax Lien i a extenslo f an eff ectiv lien, it serves to continue the priority of the state's intere tin affected property of the taxpayer. Revenue Agent p 402 471 -5835 sign Prepar s Signature Title Date Telephone Number here � Revenue Supervisor A orized Signa re Title Date - /D SEE ATTACHMFNTc