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OS/22/2006 15:59 FAX 14024714429 ------r" ~ IIr nebraska depaJ1ment of revenue NEBRASKA Dee !g] 003/007 !iT!. ".,. 9916454335-6 P9S' 1 RABANALES LAURIRNO B B Filed: OS/22/2006 02:33 PM 200604546 Please Return Original Copy to the Nebraska Dept. of Revenue at 200 South Silber, North Platte, NB 69101 Notice of State Tax Lien PLEASE DO NOT WRITE IN THIS SPACE INDIVIDUAL INCOME TAX soc. SEC. NO. NEBR., IDENT. NO. SPOUSE soc. SEC. NO. TAXABLE YEAR LIEN NO. COUNTY DATE OF NOTICE DATE OF ASSESSMENT 622505015 38063441 2001 050420304 HALL 02/11/2005, 12/02/2004 LAURIANO B RABANALES B 427 E HALL ST GRAND ISLAND' NE 68801 THIS NOTICE OF STATE TAX LIEN IS ISSUED BY THE NEBRASKA DEPARTMENT OF REVENUE FOR INDIVIDUAL INCOME TAX PURSUANT TO THE REVENUE LAWS OF THE STATE OF NEBRASKA. NOTICE IS HEREBY GIVEN THAT INDIVIDUAL INCOME TAXES INCLUDING PENALTIES AND INTEREST, WHICH ARE SHOWN BELOW ARE DUE FROM THE TAXPAYER SPECIFIED ABOVE AND REMAIN UNPAID AFTER DEMAND. THESE TAXES CONSTITUTE A LIEN IN THE COUNTY FOR PROPERTY BELONGING TO 'THE TAXPAYER OR HEREAFTER ACQUIRED. AMOUNT .OF TAX . . '. . . . . . . 224.00 PENALTY . . ... II . . .. .. . . ~ .. 11.20 INTEREST (COMPUTED TO 02/11/2005) 42.82 TOTAL AMOUNT DUE . .. . . . . . 278.02 I HEREBY CERTIFY THAT THE NEBRASKA DEPARTMENT OF REVENUE HAS COMPLIED WITH THE'REVENUE LAWS OF THE STATE OF NEBRASKA IN THE 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 TAX LIEN IS AN EXTENSION. OF AN EFFECTIVE LIEN IT SERVES TO CONTINUE THE PRIORITY OF THE STATE'S INTEREST IN THE AFFECTED PROPERTY OF THE TAXPAYER. ~tcJ.~,1wv. P~ARERIS 51 ....... .........".. AUTHOR ZED SIGNATURE 1(f,f!2!11!-k. a3'1.rf:::- - - - - - ~~: -------:----. TITLE s:! J-; (J.b/ ~~ )$"B?". ~i9 L DATE/TELEPHONE S-~O-O-&r. 1Ir................. .... DATE 'rn"'M~