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12/22/2004 18:09 FAX 14024714429 NEBRASKA UCC _ Q005/008 <br />N[ Ne e1 to - UCC sTL <br />a ( <br />9904367 65-5 Pea: 1 <br />MOYA ROG LIO A <br />200 A 1 ) 3 0 Filed! 1 /22/2004 03:00 PM <br />Y /r �,J <br />NOTICE -OFI ST TE TAX LIED <br />w wrMU� <br />PLEASE DO NOT WRIT IN THIS'SPACE <br />This Notice of State Tax Lien is issued by the Nebraska. Department of '. <br />Revenue f r unpaid taxes pursuant to the revenue laws of the state of <br />Nebraska. slotice is hereby given thatta�Ces including penalties and <br />interest, w ich are shown below, are dup from the taxpayer specified <br />below and remain unpaid after demand, These taxes constitute a lien <br />in the county for real and personal prop. rty belonging to the taxpayer <br />or hereafter acquired. <br />Nebraska Ide bfication Number Federal Identification Number <br />Lien Serial NL <br />mber <br />Lien Fil <br />Q Re'gi <br />d With <br />ter of Deeds_w El <br />, al ❑Continuatjon <br />Social Security Number s' <br />County Clerk ', 626-40 -3631 <br />.. El Corrected' Hall <br />Date of Lren.... <br />121.17/2004. _, , <br />X❑Orig' <br />TAXPAYER NAME AND MAIL <br />Rogelio A Moya <br />SINESS NAME AND LOCATION ADDRESS <br />iBusiness Name <br />Street or Other Mailing Address <br />2218 W Cottage <br />,Street Addre <br />Zip Code <br />City S <br />Grand Island <br />city <br />State <br />mount of Tax <br />0.00 <br />Penalty <br />0.00 <br />Interest <br />0.30 <br />Addltl <br />Tax <br />Category <br />Number- <br />=Oerlod <br />0110112002- <br />12/31/2002 <br />Date of <br />Assessment <br />08/05/2003 <br />01 <br />700.00 <br />140.00 <br />37.63 <br />01 <br />01/0112003- <br />12131 /2003 <br />.' 12/03/2004 <br />Social Security Nu , ber <br />ADDRESS <br />Zip Code <br />68803 <br />Balance of <br />Assessment Due <br />0.30 <br />877.63 <br />i <br />TOTAL r $ 877.93 <br />I her by-certifylhat the Nebraska Departrne of.Revenue has complied with the revenue laws of the State of Neb aka in the ; .r <br />of the amount shown to be,due .and the taxpayer has failed to pay the amount due after demand. If tl s Notice e State- <br />determination <br />Tax L en is an a ension of an effective lien, i serves to continue the priority of the state's interest in the affected p arty of the taxpaye0 <br />Revers' a Senior A ent ?Z%) ? 30P 38 <br />sign Pre are .rs Sign, re <br />Title Date Telephone Number <br />here _Revenue Supervisor Da <br />Authoriz i n ure Title 4-494- 197 aRLv_ - 002SWomedes4494- t974Ray. 10-105 <br />4 <br />