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<br />03/19/2008 WED 15:23 FAX 402 471 4429 UCC SECRETARY OF STATE ~~~ Hall <br /> <br />121003/010 <br /> <br />& <br /> <br />200802314 <br /> <br />.11111111111 <br /> <br />9908552342-4 PSG. <br />~~~a~Ei3j~7~Ql~9 10:01 AI'! <br /> <br /> <br />~ <br />tiC.lir.ilIk.;c......_1ft oM' <br />REVENUE <br /> <br />_ww.II.."'..Il'I.....n..a_ <br /> <br />NOTICE OF STATE TAX LIEN <br /> <br /> PLEASE DO NOT WRITE IN THIS SPACE <br />This Notice of State Tax Lien is issued by the Nebraska Department of <br />Revenue for unpaid ,taxes pursuant to the revenue laws of the state of <br />~ebraska. Notice is hereby given that taxes including penalties and <br />interest, which are shown below, are dLle from the taxpayer specified' <br />below and remain unpaid after demand. These taxes constitute a lien <br />in the county for real and personal, property belonging to the taxpayer <br />or hereafter acquired. <br />Nebraska Identification Number Federal Identification Number . <br />01-961111 21-5048281 <br />Lien Serial Number Lien Flied With Social Security Number Ispouse's Social Secunty Number <br />"2-:'2-Cc:56( '-"2l 00 Register of Deeds DCounty Clerk )Q(X ~ XX' -4106 <br />Date of Lien Lien .Type County <br /> 03/11/2008 l!Ioriginal DContinuat;on o Corrected HALL <br />I BUSINESS NAME AND LOCATION ADDRESS TAXPAYER NAME AND MAILING ADDRESS <br />!3uslness Name Name- <br /> JAMES A MARTINEZ <br />Street Address . Street or Other Mailing Address <br /> 3111 BRENTWOOD CIRCLE <br />City ~tate Zip Code City State Zip Code <br /> GRAND ISLAND NE 68803 <br />Tax <br />Category Tax Period Date of Amount of Tax Penalty Interest Additions Balance of <br />Number Assessment Ass85Sment Due <br />01 06/01/2006 04/19/2006 12,880.27 1,564.91 1,466.66 15,911.84 . <br />09/30/2006 <br />21 . 04/01/2006 04/19/2006 4,772.57 491.06 507.18 5,770.81 <br /> 12/31/2006 . . <br /> . <br /> TOTAL $ 21,682.65 <br />I hereb certi that the Nebraska De srtment 0 Revenue has com lied with the revenue laws of the State of Nebraska in the determination of the <br /> <br />y fy p p <br />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 <br />effective lien, it selVes to continue the priority of the state's interest in the affepted property of the taxpayer. <br /> <br />sign <br />here <br /> <br />402 595-2070 <br /> <br />Title <br /> <br />Revenue Senior Agent <br />Title <br /> <br />Date <br /> <br /> <br />Date <br />4-494-1974 Rev. 2-2002-Supersedes 4-494-1974 Rev. 10-1995 <br /> <br />(1 <br />