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10/19/2007 FRI 15:38 FAX 402 471 4429 UCC SECRETARY OF STATE ~~~ Hall 121002/003 t)CO Please forward to: Nebraska Dept of Revenue 4500 Ave I PO Box 1500 Scottsbluff, NE 69363-1500 9907530203-2 Pas: 1 ACOSTA ULISES Filed: 10/19/2007 12:42 PM 200709008 -. . r Notice of State Tax Lien nebraska departmenl ilr reven us 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 340721111 39619923 2004 062510-103 HALL 09/08/2006 06/15/2006 ULISES ACOSTA 407 KENNEDY DRIVE 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 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 . ~ . . . . . . . 195.00 PENAL TY . . . . . . . . . . . . . . . . 9 . 75 INTEREST (COMPUTED ~O 09/08/2006) . 16.38 TOTAL AMOUNT DUE . . . . . . . . . . . 221.13 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. cL~ P . A',' '~~~4i~ URE Iq41 jqt-.gPff~~@ DATE~T'LEPHONE . ~(~I;~1j~:r. . . . . . i5A~E Q'U 11115 ~0104 ' \"