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03/19/2007 15:29 FAX 14024714429 ()~ IIr n.brdka departm.nt or revenue NEBR^~KA Dee IaJ 002/004 200702121 9907501892-5 Pgs: 1 HERNANDEz JUVENRL Filed: 0311912007 09,11 ~ Please Return Original Copy to the Nebraska Dept of Revenue at 200 South Silber, North Platte, NE 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 955701643 45052506 '200S 061600481 , HALL 06/09/2006 JUVENAL HERNANDEZ 2323 BELLWOOD, DR APT 75 GRAND ISLAND NE. 68801 i : . THIS NOTICE -OF STATE TAX LIEN IS ISSUED BY THE NEBRASKA DEPARTMENT 'OF RE~ENUE FOR INDIVIDUAL INCOME TAX PURSUANT TO THE REVENUE LAWS OF THE . ST~TE OF NEBRASKA. NOTICE IS HEREBY GIVEN THAT INDIVIDUAL INCOM'E TAtES INCLUDING PENALTIES AND INTEREST, WHICH ARE SHOWN BELOW ARE DUE FROM THE TAXPAYER SPECIFIED ABOVE AND REMAIN'UNPAID AFTER DEMAND. 'THtSE TAXES CONSTITUTE A LIEN IN THE COUNTY FOR PROPERTY BELONGING TO TH~!TAXPAYER OR HEREAFTER ACQUIRED. I' AMOUNT OF TAX . . . . . . . . 293 . 00 !' i~~~ii~T. (COMPUTED' TO o6i09/2006) 1~:~~ : 'TOTAL AMOUNT DUE . . ~ . . . . . 310.30 I ~BY CERTIFY THAT THE NEBRAS-KA"'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 I ' . AMIDUNT DUE AFTER DEMAND. IF THIS NOTICE OF'ST~TE TAX LIEN IS.AN EXTENSION OF AN EFFECTIVE LIEN IT SERVES TO CONTINUE. THE PRIORITY OF THE STATE'S INTEREST IN THE AFFECTED PROPERTY QF THE -TAXPAYER. J-151J.7. /~)53$-:R.2/f l' DATE/TELEPHONE ':?-4---;- ? . . . . 10 . . . . . " . *' .. to II . . DATE ~ ,j~ .SIGNATURE