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___Q1/19/2007 15:58 FAX 14024714429 NEBRASKA Dee IaI 0021002 & Please forward to: Nebraska Dept of Revenue 4500 Ave I PO Box 1500 Scottsbluff, NE 69363-1500 . 200700484 \1111111'" 990749105 N CHRVEZ ~I:~S0~~~~/2007 12:02 PM 'r Notice of State Tax Lien nebraska department of revenue PL.EASE DO NOT WRITE IN THIS SPACE ,SOC. SEC. NO. NEBR. IDENT. NO. SPqUSE SOC. ,SEe. NO. TAXABLE YEAR LIEN NO. COUNTY' PATE'OF NoTICE DATE OF ASSESSMENT INDIVIDU~L INCOME TAX 507430375 43165699 2003 06230,0302/ HALL, '08/18/2006 06/01/2006 OSMIN CHAVEZ 'BOLANOS 311 WEST PARK AVE NORFOLK NE 68701 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 +NCLUDING PENAL~IES 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 HKREAFTER ACQUIRED. " . AMOUNT OF TAX . . . . . . .' . '. . .. .... 277.00 PENAL TY . . . . . . . . . . . . . . . ' . . .' 13 - 85 INTEREST' (COMPUTED TO 08/18/2006) . . . _ . 38.93' TOTAL AMOUNT DUE . . . . . . " . . . . . . 329.78 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 bF~ AN EFFECTIVE 'LIEN'IT SERVES TO CONTINUE THE PRIORITY OF THE STATE'S INTEREST IN THE ,AFFECTED PROPERTY OF THE TAXPAYER. . . . . .:w,~ ~~~~ P E.~' ~i~:TuRE ' ~1,!.I07 . )J05:)f,3;)-; 1.d:C:flJ .D~~JELEPHONE A'~~f??...:. . . DA. E . """ri