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<br />04/20/2006, 15: 56 FAX 14024714429 <br /> <br />NEBRASKA Dee <br /> <br />~ 007/012 <br /> <br />" <br /> <br />" <br /> <br />fJ~ <br /> <br />20060354'7 <br /> <br />111111111 ~,. nl" <br /> <br /> <br />951064451334-7 Pili: 1 <br />RRMIREZ JOSE <br />FLIed: 04/19/200602:11 PM ; <br /> <br />11, " <br />, r <br /> <br /> <br />NOTICE~ATE TAX LIEN <br />~q'7ID?'7'f ,-u.ee , <br />q ~-iDTf'tlf <br /> <br />~bto"lo;ft <br />dopo;llllll>CEJ.l <br /> <br /> . Of ")I"~l:I.1lli ,- -l]." <br /> - PLEASE DO NOT WRITE IN 1'HIS SPACE <br />This Notice of State Ta~ 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 thaUaxes including penalties and <br />interest, which are shoW" 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 taxJ)ayer <br />or hereafter acauired. <br />Nebraska Identification Number Federal h:jentification Number <br /> 36591718 <br />Lien Serial Number Lien Filed With Social Security Number Spouse's Social Security Number <br /> 971920249 . ~ Register of Deeds D County Clerk 623-10-2132 <br />Date of Lien Lien Type County <br /> 07/11/1997 o O~ginal !RI Continuation D Corrected HALL <br />-, <br />I BUSINESS NAME AND LOCATION ADDRESS TAX~AYER NAME AND MAIUNG ADDRESS l <br />Business Name Name, <br /> JOSE RAMIREZ <br />Street Address Street or Other Mailing Address <br /> .,411 N LOCUST <br />City State Zip Code City State Zip Code <br /> GRAND ISLAND NE. 68801 <br />I Tax I <br />Category Tax Period Date of Amount of Tax Penalty Interest Additions Balance of <br />Number Assessment Assessment Due <br /> 22 1995 OS/22/1997 209.00 10.45 23.29 242.74 <br /> TOTAL $ 242.74 <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 lien is exte1s' n 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 . ~-(3-0f' 402471-5928 <br /> <br />P parer's Signature Title Date Telephone Number <br /> <br />. REVENUE SENIOR AGENT ~/5-t)C.' ---~- . <br /> <br />Title Date <br />4-49t"1974 Rev. 2.2002 Superl;ede6 4-494-1974 Rev, 10-1995 \ <br />, - <br /> <br />