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09/22/2005 16:49 FAX 14024714429 NEBRASKA Dee ~ 002/002 ~ IIr l'iebra!>ka department of revenu e .. 200509436 Please Return Original Copy to the Nebraska Dept. of Revenue at 200 South Silber, North Platte, NE 69101 Notice of state Tax Lien &TL PLEASE 00 NC 9905413801-4 PIlS: 1 RAMIREZ J RAMIRO Filed: 09/22/20!6 1~:12 ~~____ INDIVIDUAL INCOME TAX 'soc. SEC. NO. NEBR. IDENT. NO. SPOUSE SOC, SEC. NO. TAXABLE YEAR LIEN NO. COUNTY DATE OF NOTICE DATE OF ASSESSMENT 449994502 40312496 2001 050420057 HALL 02/11/2005 11/30/2004 J RAMIRO-RAMIREZ 2107 N LAFAYETTE 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 INCOME TAXES INCLUDING PENALTIES AND INTEREST, WHICH ~E SHOWN BELOW ARE DUE FROM THE TAXPAYER SPECIFIED ABOVE AND REMAIN UNPAID AFTER DEMAND. THESE TAXES CONSTITUTE A LI~N IN THE COUNTY FOR PROPERTY BELONGING TO THE TAXPAYER OR HEREAFTER ACQUIRED. AMOUNT OF TAX, . . . . . . . . 333.00 PENALTY. . . . . . . . . . . . 16.65 INTEREST (COMPUTED TO 02/11/2005) 63.67 TOTAL AMOUNT DUE . . . . . . . . . 413.32 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. J.~. t. cJ-44&~, . PREPARE~SIGNATURE ~ZED'~ .~~...... tJ~~~ A d- . . . . . . . . . . . . . . . . !/~. TITLE CJ.-:JQ -P.~ /&oi)S;3.S: -ll-.94- DATE/TELEPHONE q -- 'atJ.-6S- . . . . . . . . .. .. "" . . . .. . . . DATE IIT15 10104 ~D