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04/18/2007 WED 15:14 FAX 402 471 4429 UCC SECRETARY OF STATE ~~~ Hall 121002/002 NE S.c of S........ .John t:t; Ci.l. - UCC STL o~ 9907505842-5 Pss: 1 GUTIERREZ SRNDRR Filed: 04/18/2007 02:07 PM 200703125 Please Return Original Copy to the Nebraska Dept. of Revenue at 200 South Silber, North Platte, NE 69101 ar NOTICE OF STATE TAX LIEN llobr_1ea. ~_1Il O(~ PLEASE DO NOT WRITE IN THIS SPACE This Notice of State Tax LIen is issued by the Nebraska Department of Revenue for unpaid taxes pursuantto the revenue laws of the state of Nebraska. Notice is hereby given that taxes including penalties and interest, which are shown below, are due from the taxpayer specified below and remain unpaid after demand. These taxes constitute a lien In the county for real and personal property belonging to the taxpayer or hereafter acquired. Nebraska Identification Number Federalldentiflcatlon Number 99322331 Lien Serial Number Lien Filed With Social Security Number Spouse's Social Security Number 61250073 ~ Register of Deeds D County ClerK 467-59-5702 Date of Lil!ln Lien Type County .04l12/20Q7 ~ Original 0 Continuation D Corrected hall I BUSINESS NAME AND LOCATION ADDRESS ' TAXPAYER NAME AND MAILING ADDRESS I Business Name Name SANDRA GUTIERREZ Street A!;ldress Street or Other Mailing Address 508E 19TH ST City State lip Code City State lip Code GRANO ISLAND NE 68801 I Tax Category Tax Period Date of Amount of Tax Penalty Interest Additions Balance of Number Assessment . Assessment Due 22 2003 03/16/2006 235.00 11.75 43.50 290.25 22 2004 02/06/2007 324.00 16.20 40.53 380.73 TOTAL $ 670.98 sign ... here ... I hereby certify thai the Nebraska Department of Revenue has complied with the revenue laws of the State of Nebraska in the detenninalion 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. an exten .on of allJl we lien, it serves to conlinue the priority of the state's interest In the affected 'property of the taxpayer. enue ent ' 4-/2.....07 308 535-8294 TItle Date Telephone Number Revenue $upelVisor 1./... /:J...tJ 7 Tille Date 4-494-'974 Rev. 2-2002 Supersedes 4-494-'974 Rev. 10-1995 Authorized Signature '("'/