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<br />03/15/2006 15:21 FAX 14024714429 <br /> <br />NEBRASKA Dee <br /> <br />~ 003/007 <br /> <br />200602305 <br /> <br />rlllllrlllI r <br /> <br />99164428'4-2 Pg5: 1 <br />CUEVAS-GARCIR ELMER <br />Fil.d: 03/13/2006 10:10 AM <br /> <br />\)~ <br /> <br />Please Return Original Copy to the <br />Nebraska Dept. of Revenue at 200 <br />South Silber, North Platte, NE <br />69101 <br /> <br />Ir <br /> <br /> <br />NOTICE-OF STATE TAX LIEN <br /> <br />l'\~ <br />dGOOllmlln.i <br />Q{~ <br /> <br /> PI-EASE 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 of, <br />Nebraska. Notice is hereby given that taxes including penalties aod <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 Federal, Identification Number <br /> .',. 99336308 ~, ., ! '.r ~ . ,", ....r. <br />Lien Serial Number Lien Filed With SocialSe,curity Number Spouse's Social Security N,umber <br /> 419,10132 - " , .- ~ Register of Deeds o County -Clerk 50843-9174, <br />Date of Lien ~ -- UenType _ . , C?~nty <br /> " '. 0 Cor~cted -.." <br /> 03/09/2006- : . ' '-- IKl Original 0 Continuation -, ; <br /> .. HALL --. _,_'on <br />I BUSINESS NAME AND LOCATION ADDRESS TAXPAYER NAME AND MAILING ADDRESS .1 <br />Business Name Name <br /> ELMER CUEVAS-GARCIA <br />Street Address Street or Other Mailing Address <br /> 803 5 VINE 5T APTL <br />City State Zip Code City State Zip Code <br /> GRAND ISLAND' NE 68801 <br />~ Tax 1 <br />Category Tax Period Date of Amount of Tax Penalty Interest Additions Balance of <br />Number Assessment Assessment Due <br />, <br /> 22 2001 05/01/2003 181.86 45.47 46.47 273.82 <br /> , <br /> , <br /> TOTAL $ . 273.62 ' " <br /> <br />sign ... <br />here ... <br /> <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 due, and the taxpayer has failed to pay the amount due after demand. If this Notice of State <br />Tax uen' al1 extension of an-effective lien, it serves to continue the priority of the state's interest in the affected property of the taxpayer. <br /> <br />Revenue Agent '3_qjy(p30B 535:-8294,.; <br />Title Date Telephone Number <br /> <br />Revenue Supervisor .5-9... CJ 6 ~ <br />~ . ~ - '. )1 <br />4-494'1974 Rev. 2.2002 Supersedes 4-494-1974 Rev. 10'1995 , ..) <br /> <br />