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07/29/2003 17:02 FAX 14024714429 NEBRASKA UCC 1x004 /004 <br />Please rct=to: <br />STATE OF NEBRASKA <br />DEPART -kMNT OF REVENUE <br />1811 WEST 2ND ST STE 460 <br />GRAND ISLAND NE 68803 <br />Pon; 1 <br />:20 PM <br />200909884 <br />Or NOTICE OF STATE TAX LIEN <br />depadMIM <br />44 47M" <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 too the revenue laws of the state of <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' <br />in the county for real and personal property belonging to the taxpayer <br />or hereafter acquired. <br />Nebraska Identification Number <br />Lien Filed With <br />Social Security Number <br />Spouse's Social Security Number <br />8729387 <br />X❑ Register of Deeds <br />El County Clerk <br />505 -41 -0818 <br />Tax Period <br />I <br />Lien Serial N tuber <br />Lien Type <br />Penalty <br />Date of Lien <br />County <br />Balance of <br />[]X Original EContinuation <br />0Corrected <br />07/24/2003 <br />Hali <br />BUSINESS NAME AND LOCATION-'ADDRESS- "'" " ° <br />" °' °' <br />- -- TAXPAYER NAME AND MAILING ADDRESS <br />Business Name <br />Name <br />Rigoberto Lobo <br />Street Address <br />Street or Other Malting Address <br />106 E Third Street <br />City State Zip Code <br />City <br />State Zip Code <br />(3ranri lo'',nr%A <br />Air, nnnnn <br />Tax <br />IVG <br />06oV I <br />Category <br />Tax Period <br />I <br />Date of <br />I <br />Amount of Tax <br />Penalty <br />Interest <br />Additions <br />Balance of <br />Number <br />Assessment <br />_ <br />Assessment Due <br />01 104I30/20G3 I OV0312003 I 1,171.12 I 29837 I 52.71 I I 1, 522.20 <br />TOTAL $ 1,522.20 <br />I hereby certify that the Nebraska Department of Revenue has complied with the revenue laws of the State of NebrasKa in the <br />determination of the amount shown to be doe, and the taxpayer has failed to pay the amount due after demand, If this Notice of State <br />Tax Lien is an extension an,, ffer-ttve lien, it serves to continue the priority of the state's interest in the affected property of the taxpayer. �' J <br />Revenue Senior Agent 308 385 -607 <br />SI�r1 Pr en's Slgnat Title Date <br />Telephone Numbo <br />here Revenue Supervisor <br />Authorize a Title Date <br />301 Centennial el ouch P. ox 94818 • Lincoln, lNebya -z6 68509 -4858 Phone (4dP}'4s711- ge,,-2�20V 31W3�4tv4 '4�!1�fi�8 10''9ss <br />1 <br />L <br />� 1, <br />