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<br />05/12/2006 16;05 FAX 14024714429 NEBRASKA Dee <br /> <br />14I 003/004 <br /> <br />200604231 <br /> <br />:1" Ifr", '" I:III~' I ~I <br /> <br />990645314111-2 Pes: 1 <br />MORENO DOMINIC R. <br />Fl1.d: 05/12/2006 02:36 PM <br /> <br />""\ <br />\.' <br />O~ <br /> <br />Please Return Original Copy to the <br />Nebraska Dept. of Revenue at 200 <br />South Silber, North Plarte, NE. <br />69101 <br /> <br />" <br /> <br /> <br />NOTICE OF STATE TAX LIEN <br /> <br />rulblMJo:IIo , <br />GOPllllmom <br />or~""" <br /> <br />PLEASE DO NOT WRITE IN THIS SPACE <br />This Notice of State Tax Lien is Issued by the Nebraska Department of I <br />Revenue for unpaid taxes pursuant to the revQnue 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 Federal Identification Number <br />31873464 <br /> <br />Lien Serial Number Lien Filed With <br />32130113 IZl Register of Deeds 0 County Clerk <br />Date of.Lien . .. '.".. ,.', Lien Type' .. <br />., .." , '05109/2006 :: ' ",' ~driginal 0 Continuation <br />I., - BUSINESS NAME AND LOCATtON ADDRESS <br />Business Name <br /> <br />Social Security Number <br />506~94~0396, .. <br /> <br />Spouse's Social se~urit~ Nymber <br /> <br />o Corrected <br /> <br />County.. :,:: ,".' <br />. ~.'>. HALL' <br /> <br />TAXPAYER NAME AND_MAILING ADDRESS <br /> <br />I <br /> <br />Street Address <br /> <br />Name <br />DOMINIC A MORENO <br />Street or Other Maillhg Address <br />321 N DARR <br /> <br />City <br />I Tax <br />Category Tax Period <br />Number <br />22 2000 <br />22 JDoJ,.. <br />, <br /> <br />State Zip Code City State Zip Code <br /> GRAND ISLAND NE 66803 <br />Date of Amount of Tax Penalty Interest ' Additions Balance of I <br />Assessment Assessment Due <br />05/16/2003 121.00 196.00 267.24 584.24 <br />06/25/2003 179.00 8.95 32.95 220.90 <br /> \ <br /> <br />TOTAL:,', ~ :'-., <br /> <br />$ <br /> <br />805.14.. <br /> <br />.... <br />,sign. <br />here ... <br /> <br />I hereby certifY that the Nebraska Department of Revenue has complied with the revenue laws of the ~tate of Nebraska in the <br />'determination ,of the amount shown to be due, and thf1 taxpayer has failed to pay the amo~nt due after demand. If this Notice of State <br />Tax Lien an exte-nsion of an !i!,ffective lien, it serves to continue the priority of the state's interest in the affecied p-roperly ofthe taxpayer. <br />, ' --' .' .'. ..--, <br />>1Du L Revenue AQent ,-J -4 -tf) 0'3Q8 53,~~82,9.4 . <br />p~ arer's Title Date Telephone Number <br />Revenue Supervisor - 0--7'-06. , <br />~ ' D~ ~ <br />~-'\94'197,~ Rev. 2-2002 Supersedes 4-494-'974 Rev. '0..1995 "x.~ <br /> <br />