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<br />12/15/2006 16:55 FAX 14024714429 <br /> <br />NEBRASKA Dee <br /> <br />~ 004/005 <br /> <br />~-....... <br /> <br />.... <br /> <br />Dca <br /> <br />200611136 <br /> <br />1I1~IIIn I~'.l r <br /> <br />9906485316-3 PSIs; 2 <br />TOPETE BERNAL <br />FlIed: 12/15/2006 02,57 PM <br /> <br />nob/uk.. <br />dopllu:lmom <br />of fG"_ <br /> <br /> <br />If" <br /> <br />This Notice of State Tax Lien is issued by the Nebraska Department of <br />Revenue for unpaid tax s pursuant to' the revenue laws of th, state of <br />Nebraska. Notice is herfY given that taxes Including penalties. and <br />interest, which are sho n below, are due from the taxpayer specified <br />below and remain unpai after. demand. These taxes constitute a lien <br />in the county for real an personal property belonging to the taxpayer <br />or hereafter ac uireq. <br />Nebraska Identification Number Federal Identification Number <br />36446270 <br /> <br />963270050 <br /> <br />......~'r <br /> <br />Uen Filed With Social Security Number <br />IKJ Register of Deeds 0 County Clerk 560-75-3170 <br />Lien Type County <br />D Original ~ Continua lion D Corrected HALL <br /> <br />Spouse's Social Security Number <br /> <br />Lien Serial Number <br /> <br />Date of Lien <br /> <br />01/17/19971 <br />I <br />... BUSINESS N~E <br />Business ~ame <br /> <br />.- "~' ~:,~~ .' <br /> <br />~.LOCATION ADDRESS <br /> <br />TAXPAYER NAME AND MAILING ADDRESS. <br /> <br />Name <br /> <br />City <br /> <br />State <br /> <br />Zip Code <br /> <br />BERNAL TOPETE <br />Street or Other Maili[lg Address <br />4101 E GORDON DR LOT 106 <br />City State <br />SIOUX CITY IA <br /> <br />Zip Code <br />51106 <br /> <br />Street Address <br /> <br />1992 <br /> <br /> <br />Amount of Tax <br /> <br />Penalty <br /> <br />Interest <br /> <br />Additions <br /> <br />Balance of <br />Assessment Due <br /> <br />. Tax <br />Category Tax Period <br />Number <br /> <br />22 <br /> <br />166.00 <br /> <br />8.30 <br /> <br />48.22 <br /> <br />222.52 <br /> <br />TOTAL <br /> <br />$ <br /> <br />.222.52 <br /> <br />sign ... <br />here ... <br /> <br />I hereby certify that the N1ebraska Departnient 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 an ension ~f 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 1:>-/ Sf 0(, 402 471-5928 <br /> <br />Title Date Telephone Number <br /> <br />REVENUE SENIOR AGENT /;t - S- -C) " <br /> <br />Title 4-494-1974 Rev. 2-2002 sU~~:de$ 4--494.1974 Rev, 10.19ctJ <br />SEE AlTACHMENTS .\:d\ <br /> <br />