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07/20/2004 08:35 FAX 14024714429 NEBRASKA UCC Q004 <br />Or <br />nabraska <br />department <br />Ofrevenue <br />200407158 <br />M s.e of 94040 - UCC STL <br />9964342788 -6 Pas: 1 <br />RAMIREZ GUILLERMO <br />Filed: 07/16/2004 04:07 PM <br />Notice of State Tax Lien <br />PLEASE DO NOT WRITE IN THIS SPACE <br />INDIVIDUAL TA NCOMS TAX <br />SO' Co SECa No& 55153-1366 <br />NEBR• IDENTs NC ,@ 399 70 <br />SPOUSE:: SOC• SEC- NO— 624243388 <br />TAXABLE YEAR 2aaOG <br />LIEN a CUILLER-114J .RAMIREZ <br />COUNTY HALL FELIPA TO-RRES RAMIREZ <br />DATE OF NOTICE 01/09/26c4 PO BOX 2505 1416 X11 ANNA ST APT I <br />DATE OF ASSESSIMENT 10/30/2003 GRAND ISLAND NE 68802 <br />THIS NOTICE OF STATE TAX LIEN IS ISSUED BY THE NEBRASKA DEPARTMENT Cf <br />ZrVEMUE FOR INDIVI3UAL INCOME TAX PURSUANT TO THE REVENUE LAWS OF THE <br />STATE F NEBRAfiK1 • N:JTICE IS HEREBY GIVEN THAT INDIVIDUAL INC3ME <br />TAXES 14CLUDINC PENALTIES AND INTERESTi WHICH ARE SHO .BELOW ARE DUE <br />FRS THE TAXPAYER SPECIFIED ABOVE AhT REMAIN UNPAID AFTER DE1400* <br />THESE TAXES CONSTITUTE A LIEN IN THE COUNTY' FOR PROPERTY BELONGING TO <br />THE. TAXPAYER OR HEREAFTER ACQUIREDo <br />AMOUNT OF TAX s• s• a a a a• a • s r s e s a 1057703 <br />PENALTY* woo • a s a a• s• a �i2a�5 <br />INTEREST (COMPUTED TO 1/09 /Zeb4 r • • • s s s • 227e86 <br />TOTAL AMOUNT DUE • a s • • • . • • • • e s • • a 1037 -73 <br />1 HEREBY CERTIFY THAT THE IEBRA;K�, DEPA;TNENT C.; REVENUE HAS COMPLIED <br />WITH THE REVENUE LAWS OF T`!E STATE OF NEBRASKA IN THE DETERMINATION OF <br />THE AMOUNT SHOWN TO BE DU?E9 AND THE TAXPAYER HAS FAILED TO PAY THE <br />AN13U NT DUE AFTER DEMAND- IF THIS NL*TICE 13F STATE TAX LIEN IS AN <br />EXTENSION OF AN :EFFECTIVE LIEN IT SERVES TU CONTINUE THE PFaORI1TY OF <br />THE STATESS TNT EREST IN THE .AFFECTED PRO? -CRTY OF THE TAXPAYER• <br />PREP <br />i as s . las.`r / <br />R!S Si TIT <br />•a••! • �•r • rR' #73• 7A0ls4.• sal�if� ��laa•irli <br />OR.I2E SIGNATURE TITLE ?SATE <br />C � <br />C <br />NEBRASKA DEPARTMENT OF REVENUE - White and Canary Copies TAXPAYER - Pink Copy <br />soy n recycled paper 7- 145 -1979 Rev. 2 -2000 Supersedes 7 -145 -1979 Rev. 10 -1995 <br />