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10/04/2007 THU 15:25 FAX 402 471 4429 UCC SECRETARY OF STATE ~~~ Hall 121003/004 o~ Please forward to: , Nebraska Dept of Revenue 4500 Ave I PO Box 1500 Scottsbluff, NE 69363-1500 200708585 9907528491-7 pgs: 1 FLORES MIGUEL A Fi18d: 10/04/200703:15 PM IIr Notice of State Tax lien l1ebraska departmel1t of r8\lel1ue PLEASE DO NOT WRITE IN THIS SPACE INDIVIDUAL INCOME TAX SOC. SEC. NO. 506134378 NEBR. IDENT. NO. 99519208 SPOUSE SOC. SEC. NO. TAXABLE YE~R 2005 LIEN NO. 071870277 'COUNTY HALL '......1)ATEm.OF-:NOTICE ... ,. , .. .....07/06/2007 .. DATE OF ASSESSMENT 04/24/2007 MIGUEL A FLORES 2012"WTITH"AVE' GRAND ISLAND NE 68803 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 INCLUDING PENALTIES AND INTEREST, WHICH ARE SHOWN BELOW ARE DUE ~ROM 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. :===-=:==::==~::.:....:.::::fdvl~~N'f:-~F:~'!'A*:::.:',-.....:::.._,;-...--:..:.:" .... .........._... m__..__,.l-:rO:SO,.OO". .......... .... .... PENALTY . - - . - - . . . . . . . . ~ _ . . . .. 52.50 INTEREST (COMPUTED TO 07/06/2007) . . . . . . .. 85.55 TOTAL AMOUNT DUE . . . . . . . -. . . _ . . . . . 1,188.05 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 TATE'S INTEREST IN THE AFFECTED PROPERTY OF THE TAXPAYER. ~ . al~.1;. . . .. . If! 1f.1:./~)~{;.Il<<J TU r':."'" . . DATE/TELEPHONE lIT 10