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03/19/2008 WED 15:23 FAX 402 4714429 UCC SECRETARY OF STATE ~~~ Hall 121004/010 QJ 200802315 ~ NebJ....io:., o......_nt ~ REVENUE WIlIo'V1r...__"u..,,._.a_ NOTICE OF STATE TAX LIEN PLEASE DO NOT WRITE IN THIS SPACE This Notice of State Tax Lien Is Issued by the Nebraska Department of Revenue for unpaid taxes pursuant to the revenue laws of the state of Nebraska. Notice Is hereby given that taxes including penalties and Interest, Which are shown beloW, are due from the taxpayer specified below and remain unpaid ,after demand. These taxes constitute a lien in the county for real and personal property belonging to the taxpayer or hereafter acquired. . Nebraska Identification Number Federalldenlificatlon Number 01-961111 21.,5048281 Lien Serial Number Lien Filed With ,ISOcial Security Number Spouse's Social Security Number Z "?oDaCO'i'8 [&jRegister of Deeds o County Clerk '#X-XX -6450 Date of Lien Lien Type County 03/11/2008 . 00 Original Dconlinuation o Corrected HALL BUSINESS NAME AND LOCATION ADDRESS TAXPAYER NAME AND MAILING ADDRESS Business Name Name LYDIA JEAN MARTINEZ' Street Address Street or Other Mailing Address. 105 PLETCHER TERRACE City titate Zip Code City State' Zip Code GRAND ISLAND NE 68803 Tax Category Tax Period Date of Amount of Tax Penalty Interest Additions Balance of Number Assessment Assessment Due '()1 06/01/2006 04/19/2006 12,880.27 1,564.91 1,466.66 15,911.84 . 0_9/30/2006 . 21 04/01/2006 04/19/2006 4,772.57 491.06 507;18 5,770.81 12/31/2006 . TOTAL $ 21,682.65 I hereby certify that the Nebraska Department of Revenue has complied with the revenue laws of the State of Nebraska In the deterrnlnalion 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 selVes to continue the priority of the state'sinlerest in the affected property of the taxpayer. Title Revenue Senior Agent Tille 402 595.2070 TelerOn,NUmber J j) oOr Dald 4-494-197" Rev. 2~2002 Supersedes "-494-197" Rev. 10.1995 sign here ... . preparer'~nature /' .~ __ (~(o~W'- Authorized Signature Date Qf.)