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04/22/2005 16:05 FAX 1.4024714429 NEBRASKA UCC IM 002/003 ..... . . . . . . 200503670 NE Me of S4a40 - UCC STL 99053$1079 --4 Paz; 1 Fi/l:d: 04/22/2005 12:54 PM NOTICE OF STATE TAX LIEN PLEASE DO NOT WRITE IN THIS SPACE 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 vounty for real and .personal property belonging to the taxpayer or hereafter ac uired. Nebraska Identification Number Federal Identification Number 37071408 Lien Serial Number Lien Filed With Social Security Number Spouse's social Security Number 42680278 ❑X Register of Deeds []County Clerk 606 -64 -6421 Date of Lien Lien Type County 04/21/2005 original Continuation Corrected HALL BUSINESS NAME AND LOCATION ADDRESS TAXPAYER NAME AND MAILING ADDRESS Business Name Name Street Address City Tax Category; Tax Period JUAN M JUNES DE LEON Street or Other Mailing Address 247 S VINE Stato Zip Code -C--It--y Data of 22 I 2002 1 0810112004 Amount of Tax 244.00 GRAND ISLAND Penalty Interest 12.20 ' 29.51 1 State Zip Code NE 68801 Addltions Balance of Assessment Due 285.71 TOTAL $ 285.71 I hereby certify that the Nebraska Department of Revenue has complied with the WE laws of the Slate of Nebraska in the deterrilination of the amo shown to be due, and the taxpayer has failed to pay the amount due after demand. If this Notice of State Tax Lien ' tens' an effective lien, it ryes to continue the priority of the state's Interest In the affected ro e p p rty of the taxpayer. 00. t y�Q -oW 57 402 471 -5835 sign 00. Signature Revenue A en True Date Telephone Number here I, Senior Revenue Agent thorized Sign re Title — ° ze - OSJ i Date