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06/07/2007 THU 15:19 FAX 402 471 4429 UCC SECRETARY OF STATE ~~4 Hall 1210021002 0% nebraska department of revenue IIr 200704712 Please Return Original Copy to the Nebraska Dept. of Revenue at 200 " . -S - ::t' .h- '?l..l-b- .--- ~-lorth~jatte. .N~__..:...~:=.._~-------': ------~-----~_,._---------.--.- eu 13 "'.,1"1 , 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 584794803 43799078 2004 070680214 ,HALL 03/09/2007 12/21/2006 MARIEL CRUZ MORALES PO BOX 1341 GRAND ISLAND NE 68802 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 ST~TE OF NEBRASKA. NOTICE IS HEREBY GIVEN THAT INDIVIDUAL INCOME TAXES INCLUDING PENALTIES 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 HEREAFTER ACQUIRED. AMOUNT OF TAX . . .. . . . . . 3,560.'91 PENALTY'. . . . . . . . . . . .. ... 178.05 INTEREST (COMPUTED TO 03/09/2007) ... 418.92 TOTAL AMOUNT DUE . . . . . . . .. .... 4, 157 . 88 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 OF AN EFFECTIVE LIEN IT SERVES TO CONTINUE THE PRIORITY OF THE STATE'S INTEREST iN THE AFFECTED PROPERTY OF THE TAXPAYER. b[.c9~.. PR ARER'S 51 We#.~ a~..... TJ: . . .~V;": ~ . . . . . . . . . . . . . TITLE ~ .'$.~ 1 ~/ft:)$-:~Z9 '1 DATE/TELEPHONE . .I.~~-:~:'. . . . . . . . . . DATE SIGNATURE \}-/ IIT1510104