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07/20/2004 08:36 FAX 14024714429 <br />Or <br />nebraska <br />department <br />of revenue <br />NEBRASKA UCC <br />200407159 <br />IA 005 <br />ME Sac W S404► - ticc SrL <br />Ps <br />TREJO TAYRA M PEREZ <br />Fil*d-. 07/16/2004 04:07 PM <br />Notice of State Tax Lien <br />PLEASE DO NOT WRITE IN THIS SPACE <br />1NDIVIDUAL INCOME TAX <br />S0C* SEC• NO• 5 a 12 9 5 3, 4 4 —4 <br />HIEBRo WENT,* N0- A 50403 <br />we rli$s SS- C. SEC* NO'D <br />TAXABLE YEAR .20-00, <br />LIEN 6400 0406-50057 <br />COUNTY HALL TAYRA -M PEREZ TREJO <br />DATE Of NOTICE C-3/05/2004 2016 W 11TH AVE <br />,ATE OF ASSESSMENT 01/15,M64 GRAM ISLAND NE 68803 <br />a DEPART, NOTICE OF STATE' TAX LIEN IS ISSUED BY THE NEURASKA DEPART, _h'T OF <br />Rr: EN X FOR I KINIVIDUAL INCONE TAX PURSUANT TO THE REVENUE LAWS OF THE <br />STATE OF NERRASKAi NCTICS IS HEREBY GIVEN THAT INDIVIDUAL INCOME <br />TAXES INCLLMING PENALTIES AND INTEREST # WHICH ARE SHOWN $ELOW ARE DUE <br />FRON THE TAXPAYER SPECIFIZED ABOVE AND REMAIN UOPAID AFTER DERAND& <br />THESE TAXES CONSTITUTE A LIEN TH THK COUNTY FOR PROPERTY BELf-WIGING TO <br />THE TAXPAYER OR HERFAFTER ACWIRED-0 <br />A-MM M. OF TAX 0 a a 0 0 a ft 0 a 49 63-7060 <br />PENALTY--- * ;000 eime,*** 0 00 oft 00 0 0 30*85 <br />INTEREST (tGMPUUD,T,9 0.3/05/Z0104) 138-70 <br />TCTAL AMOUNT DUE 786*55 <br />1 HEREBY CERTIFY THAT THE NEBRASKA BEPARTIA KT OF REVENUE HAS CC_jA.PLIFD <br />WITH -rriE RIEVEME LAWS C-F THE STATE Of NEBRAM IN THE DETERRiNATION OF <br />THE AMOUNT SHOWN TO BE DUEip Al D THE TAXPAYER HAS FAITLED TO PAY THE <br />AF; IT DUE AFTER DEMAND- IF THIS NOTICE OF STATE TAX LIEN IS AN <br />EXTENSION OF AN EFFECTIVE 1. iN IT SERVES TC CONTIN <br />Ur- THE PRIORITY OF <br />THE STATEN'S INTEREST 11,14 7HE, AF',=_CTFD PROPFRTY OF TOE '11AXPAYERe <br />7 PREP- uRfs S 9 TMR 1-1-ITLE 10AT"EMLEPHONE a <br />ti <br />THWOR;Z'�D SIGNATURE T: E T LIVE DATE <br />— NEBRASKA DEPARTMENT OF REVENUE — White and Canary Copies TAXPAYER — Pink Copy <br />Pnnted with soy ink on recycW. paper 7-145-1979 Rev. 24000 supersedes 7-1451979 Rev. 1 D -1996 <br />