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12/13/2007 THU 14:37 FAX 402 471 4429 UCC SECRETARY OF STATE ~~~ Hall ~002/003 db ,< Please forward to: Nebraska Dept of Revenue 4500 Ave I PO Box 1500 Scottsbluff. NE 69363-1500 200710394 Ir Notice of State Tax Lien nebraska department or revenue 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 581336538 98753576 2005 072010484 HALL 07/20/2007 05/01/2007 JOSE RAMOS 511 W CHARLES GRAND ISLAND NE 68801 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 INCO~E 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 .'. . . . . . . . . . .. 497 .00 PENALTY . . . . . . . . . . . . . . . '. .... 24.85 INTEREST (COMPUTED 'TO 07/20/2007) .. . 43.13 UNDERPAYMENT OF ESTIMATED TAX PENALTY . '0.00 TOTAL AMOUNT DUE . . . . . . . . . .. . '. .. 564 . 98 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. .~. .q~.. '..... /t/!!/o:1: ./(t)i2W;(1fJ!J TI E ' DATE T EPHONE , ) O/fH AUTHORIZED SIGNATURE