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<br />08/21/2006 16:54 FAX 140247J4429
<br />
<br />NEBRASKA Dee
<br />
<br />~ 002/005
<br />
<br />e~,
<br />
<br />
<br />9986411548-5 Pg!ll: 1
<br />ESPINOZA MRRGARITO
<br />FJ1.d: 88/21/2006 09:37 AM
<br />
<br />.200607481
<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 />IIr
<br />
<br />
<br />NOTICE OF STATE TAX LIEN
<br />
<br />116\l1IUkJo
<br />ilt~~
<br />OC'~
<br />
<br />PLEASE DO NOT 'J!IRlTE IN THIS SPACE
<br />
<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 and
<br />interest, which are shown below. are dile 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 />Nebriilska Identification Number
<br />
<br />Federal Identification Number
<br />
<br />38866404
<br />
<br />Lien Serial Num~e_r lien,Flled With
<br />" 962949,q1.~ ,_ ",', ,., ,^ ~.~egist~r,of De_edi!
<br />Date of,Llen - ::. :";".' :'. ". ,. ~".: ':':,': ,.> Uen'Wpe'o
<br />:":.~" ,':~' 19r.~~h~9~:"><' .,'.~'. ',:'" , [J.o'rigi~a; "I!l Contin_Uiiti~n .'
<br />I .. ,-BUSINE~.S'NANlE AND LOCAT.lo,i11 ADDRESS, _ __ ..... ,..."
<br />. Busines~ Na.rti-e'" - , .-
<br />
<br />Social Security _l\Iumber
<br />D County. Clerk 483-13-0583
<br />
<br />Spouse's Social Security N\l.mber
<br />
<br />,j'_'I. " I.
<br />
<br />Street ~ddress
<br />
<br />County.::,,-, .' "-,,,
<br />Dc~rr'ecfed. '.,:>::--H'ALi~."'.~~;,. .'.,,' .:'>'<'~'::::~:';:h:':': ',.. ".
<br />
<br />.. ,_",,' .' TAXPAY.ER.NANlEAND MAILING ADDRESS- " .
<br />Name ; .
<br />MARGARITO- ESPINOZA -
<br />Street or Other Mailing Address
<br />PO BOX 694
<br />
<br />...."., I
<br />
<br />City
<br />
<br />State
<br />
<br />Zip Code
<br />
<br />City , State Zip Code
<br />GAAND ISLAf.m NE 68802
<br /> .. . , '1
<br />Penalty Interest Additions Balance of
<br /> Assessment Due
<br />15.95 : "f' 14:55 349.50' ,
<br />' '
<br />
<br />I ca~:ory Tax Period Date of
<br />Number" Assessment
<br />
<br />Amount of Tax
<br />
<br />22 - 1995' 09/03/1996
<br />
<br />319.00
<br />
<br />lJ.-ie ~
<br />l:n ;r -:'
<br />
<br />,.,.>..'--- --.....
<br />
<br />(' .r 08'1 I.,";' i J . "'\
<br />
<br />---....._-~~
<br />
<br />~~ 4fJ1'107.-
<br />
<br />.... ." .. "- -.,
<br />
<br />-. ';"
<br />I, ." ...._,.,
<br />
<br />'-. ,,--TOTAL
<br />
<br />'$";-"- :.... "349.50-
<br />
<br />,''-''
<br />":1:
<br />
<br />~'," '.
<br />
<br />sign ...
<br />here Ii>-
<br />
<br />I hereby.'c~rti,fy that.the Nebraska pepart'!lsnt of Revenue has complied with the revenue laws ofthe, State of Nebr~ska In the
<br />. determination of the amount shown to be due;_8nd the taxpayer has failed to pay the amount:due after demand.. If thiS f:Jpllce of State, ..
<br />-.:: '.:.~_. laiC. Lien . ari .eJg.en~ior:l of,an ~ffecti!le 'lien,_ it'~erves to continue th,e priority of the state's int~re~t.ln the affected property.of the_taxpayer.." .. .. -
<br />
<br />-:.. ". ':"', -~:.. 'Rev~~ue' Agent 1-/0 -ofo . 308 535-8294
<br />
<br />~S ae ~ ~ ~-~~~
<br />
<br />-' Revenue Supervisor. - ;: Y'O-~'
<br />Title Date
<br />~-'l9<4-1974 RBv, 2-2002 SUpB~Bd'l$ 4-49<1.1974 Rev. 10-1995
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