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09/10/2004 10:54 FAX 14024714429 NEBRASKA UCC IA 004/005 0g 200409021 fi f.0 of ff.+. - UCC sn. 9904349793 -4 Pos: 1 MOLINA SICIFREDO Filed: 09/t0/2004 10:10 AN 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 Lien Filed With Social Security Number Spouse's Social Security Number 35050217 X❑ Register of Deeds XE] County Clerk 507 -23 -9050 Lien Serial Number Lien Type Date of Lien County 030450210 XD Original []Continuation Corrected 09/0312004 HALL BUSINESS NAME AND LOCATION ADDRESS TAXPAYER NAME AND MAILING ADDRESS Business Name Name SIGIFREDO MOLINA Street Address Street or Other Mailing Address 243 S LOCUST APT 3 City State Zip Code City State Zip Code GRAND ISLAND NE 68801 Tax Category Tax Period Number Date of Amount of Tax Assessment Ponalty Interest Additions Balance of Assessment Due 22 1999 10131/2002 1,454.00 77.85 533.46 2,065.31 TOTAL $ 2,065.31 r nerevy cerury that the Nebraska Department of Revenue has complied with the revenue laws of the State of Nebraska in the ��1 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 Lieaian extension of an effective 'en, it serves to continue the priority of the state's interest in the affected property of the taxpayer.-r' Revenue Agent q-3-0V 402 471 -5835 Sign Prepar s Signature Title Date Telephone Number here /o �F.r17- orized Si gna r -Title �� Date