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02/07/2002 17:17 FAX 14024714429 NEBRASKA UCC 0002/003 <br />Or <br />anic. <br />d"Mrim.et <br />200201522 <br />Notice of State Tax Lien <br />- <br />PLEASE DO NOT WRITE IN THIS SPACE <br />This Notice of State Tax Lien is issued by the Nebraska Department of <br />Revenue for unpaid taxes pursuant to the revenue laws of the state or <br />Nebraska. Notice is hereby given that taxes including penalties and <br />interest, which are shown below, are due from the taxpayer specified <br />below and remain unpaid after demand. These taxes constitute a lien in <br />the county for real and personal properly belonging to the taxpayer or <br />hereafter acquired. <br />Nebraska IdemMnation Number <br />35688491 <br />Lien Red With <br />CRRBOisterof Deals 0 County Clerk <br />Socia Secunlyor rederel l.D. Numbar <br />604 -18 -1705 <br />Spouae's Sadal Security Number <br />946 -78 -5641 <br />Lan Surd Number <br />003430307 <br />Lien Type - <br />[ orVnei C]Conanuatln []Corroded <br />uses of Led <br />01 -30 -02 <br />County <br />HALL <br />BUSINESS NAME AND LOCATION ADDRESS <br />I TAXPAYER NAME AND MAILING ADDRESS <br />Business Name <br />Name & S RODRIQUE <br />MARTIN MONTELONGO SOLORZ <br />�Sreet <br />Street AddrOSS <br />or Uher MelAO AMOISS <br />1103 W 11TH ST <br />City State Zip Code <br />City State Code <br />GRAND ISLAND NE 6881 <br />°1L <br />Category <br />Number <br />Tax Pxlod <br />Date of <br />Aaaesxnatt <br />Amount of Tax <br />Penalty <br />IMSxsat <br />Additions <br />Balencect <br />Aaee.enalMDue <br />22 <br />1997 <br />10 -23 -00 <br />592.00 <br />29.60 <br />202.32 <br />823.92 <br />_ <br />Please retum to: <br />I <br />STATE OF NEBRASKA <br />DEPARTNIEN1' OF REVENUE <br />1811 WEST 2N0 ST STE 460 <br />- GRAND ISLAND NE 68603 <br />TOTAL <br />$ 823.92 <br />Z <br />I hereby candy that the Nebraska Department of Raysnue has oompfled with the nwenue laws of ON State of Nebraska In rte netenneiaoon <br />d me amount shown to be due, and the taxpayer has failed to pay me amcum due after demand. [MIS Notice of State To Lien is sn extension of <br />ant effe teIk b serves to adminusi Me prlorry Of the State's interest In lna affected property of the taxpayer. <br />sign 1 /5S / -,V ,3 51rG <br />here Roo rs slgr stun V TWO Cate TelephoneNo <br />- <br />rat TMe ° r <br />NE KA DEPARTMENT OF REVEMh - Wride and Goldenrod Copies TAXPAYER Pink Copy F COUP DeaFS 1pCirEvd�as 1 74 Rp am l <br />rmae . .rw ar <br />