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04/16/2004 16:22 FAX 14024714429 NEBRASKA UCC Q 003 /006 V tr N[ Sic of ibis -UCC SCON 9904328900 -8 Pps: 1 NUNEZ ORNIEL REYES Filed: 04/16/2004 09:55 AM 200403808 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 acquired. PLEASE DO NOT WRITE IN THIS SPACE Nebraska Identification Number 34099689 Lien Filed With X] Register of Deeds ❑ County Clerk Social Security Number 506 -25 -3270 Spou4w'sSocial Security- Nomber� Lien Serial Number 922340196 Lien Type Original r0 Continuation ' } E] Corrected Date of Lien 1 08121/1992 County HALL BUSINESS NAME AND LOCATION ADDRESS -- -- TAXPAYER NAME AND MAILING ADDRESS Business Name Name DANIEL REYES NUNEZ Street Address Street or Other Mailing Address 310 WEST 7TH ST APT 2 City State Zip Code City State lip Code GRAND ISLAND NE 68801 Tax Category Number Tax Period Date of Assessment I Amount of Tax Penalty Interest Additions Balance of Assessment Due 22 1989 07/14/1992 198.00 9.90 66.22 274.12 I i.e s1,.♦ e.s:c.. iL...� tL -. At_L ___.__ n TOTAL $ 274.12 ,o, �..r —. �,r u is < e , eb a5ra ueparunent or Revenue has compii 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 i n exten ' h of an a ctive lien, it serves to continue the priority of the state's interest inntthe affe led property of the taxpayer. ( Revenue Agent /� / 402 471 -5835 t}, sign Preparers Signature Title Date Telephone Number : C,[ Z� / z Revenue Supervisor y_ -r — p y Title Date here 110.