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<br />03/26/2007 15:39 FAX 14024714429 <br /> <br />NEBRASKA Dee <br /> <br />14I 003/003 <br /> <br />200702378 <br /> <br />'1lllllM r If I r <br /> <br /> <br />9907582323-2 p",: 1 <br />PENA.CHRISTINR <br />F~l.d: 03/26/2007 03:e5 ~ <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 />l' <br /> <br />I" <br />Ir <br /> <br /> <br />NOTICE OF STATE TAX LIEN <br /> <br />__lea <br />doll4l_olll <br />Of,~ <br /> <br /> PLEASE DO NOTWRITE IN THIS SPACE <br />This Notice of State Tax Lien is Issued by the Nebraska Department of <br />.Revenuecfor unpaid taxes, pursuant to,the revenue laws 'of the state of <br />Nebraska. Notice is .hereby given that taxes including penalties and <br />interest, whlct, are shown below, are due from the taxpayer specified . <br />below and remain' unpaid after demand. These taxes constitute a lien <br />in ihe County for real and personal property belonQ,lng to the taxpay~r <br />or hereafter acauired. ' ' <br />Nebraska Identification Number Federalldel\tiflcation Number <br /> '43149510 <br />Lien Serial Number Lien Filed With Social Security Number Spouse's Social Security Number <br /> '.61250056 I2S] Register of Deeds o County Chilrk . 454M37 -3133 ' <br />q~te of Lien . Lien Type County' . . . <br />' , "' <br /> 03/21/2007 I2S] Original 0 Contl~uation o Corrected HALL .. <br /> '. <br /> - , <br />I BUSINESS NAME AND LOCATION ADDRESS TAXPAYER NAME AND MAILING ADDRESS . . ....1 <br />Business Name Name <br /> Christina Pena <br />Street Address Street or Qther Mailing Address <br /> , 404 1/2 W 12th St <br />, City Slate Zip Code City State lip Code <br /> Grand Island NE 68801 . <br />I Tax I <br />Category Tax Period Date of Amount of Tax Penalty Interest Additions Balance of <br />Number Assessment Asse$sment Due <br />22 2003 03/1612006 184.12 21.90 69.86 275.88 <br /> .. <br /> TOTAL. . $ 275.88 .. . <br /> <br />sign .. <br />here .. <br /> <br />I hereby certify that tne Nebraska Department of Revenue has complied with the revenue laws of the State of Nebraska in .the <br />determina!' n of the amount shown to be due, and the taxpayer has failed to pay the amount due after demand. If this Nollce of State <br />Tax Lien I n extension ota effective lien, it serves to continue the priority of the state's interest in the affected property of the taxpayer. <br /> <br />~ evenue Agent JZI-v 7 308 535-8294 <br /> <br />parer's Sign Title Date Telephone Number <br /> <br />Revenue Supervisor ..)-;;..~-" 7 <br />Tille Date <br />4-494-1974 Rav. 2-2002 Supar.sd". 4-494.1974 Rav. 10-1995 <br /> <br />