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04/16/2004 16:22 FAX 14024714429 Or NEBRASKA UCC Q 002/006 328N8-1 p8s; Filed: 04/1612004 09:55 AM 200403807 NOTICE OF STATE TAX LIEN PLEASE DO NOT WRITE IN THIS SPACE 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 acquired. d Nebraska Identification Number Lien Filed With �Clerk Security Number tY 'Spouse's- Social Seeurjty -titan; 34099689 XX Register of Deeds 06 -25 -3270 Lien Se rial Number Lien Type ____.--- -) Date of Lien, County 952490657 11 Origi Y'- Continuation ,f 0 Corrected 09/06/1995 HALL BUSINESS NAME AND LOCATION AI RESS .,�,._r ,- �_..�. • TAXPAYER NAME AND MAILING ADDRESS Business Name Name DANIEL R NUNEZ Street Address Street or Other Mailing Address 1414 ST PAUL RD 1 F City State Zip Code City State Zip Code Tax GRAND ISLAND NE 68801 Category Tax Period Date of Amount of Tax Penalty Number Assessmont Interest Additions Balance of 22 1994 06/09/1995 I 93.76 1 4.69 1 3.33 101.78 TOTAL $ 101.78 I hereby certify that the Nebraska Department of Revenue has complied with the revenue laws of 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 is a 1 xtension an effecti a lien, it serves to continue the priority of the state's interest in the affected property of the taxpayer. Revenue Agent L[-- 402 471 -5835 sign par Signa "Fe Title Date Telephone Number here -- y; Revenue Supervisor Au orized Signatur Title y- Date f