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<br />06/05/2008 THU 14:40 FAX 402 471 4429 UCC SECRETARY OF STATE ~~~ Hall <br /> <br />1ZI002/003 <br /> <br />Please forward to: <br />Nebraska Dept of Revenue <br />4500 Ave I PO Box 1500 <br />Scottsbluff, NE 69363-1500 <br /> <br />\1111"'11' <br /> <br /> <br />9908562098-7 pg <br />FI,.OREdS ElllR6tl~~'~1ll1lla 02:05 PM <br />Fila: <br /> <br />D~ <br /> <br />200804885 <br /> <br /> <br />. - .... ........,. . ',. - ., '...- <br />~ ~ ~ ." <br />Nlebr.",k/l1 O......nnwnt _ <br /> <br />REVENUE <br /> <br />www..........rn.ll.........av <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 pur~uant to the revenue laws of the state of <br />Nebraska. Notice is hereby given that taxes including penalties and <br />interest, which are shown below,are due from the taxpayerspecifled <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 /> 98795627 <br />Lien Serial Number Lien Filed With Social Security Number Spouse's Social Security Number <br /> 70050469 l!IRegister of Deeds Dcounty Clerk XXX-XX-4495 <br />Date of Lien Lien Type County <br /> 06/02/2008 l!IOriginal DContinuation o Corrected Hall <br />BUSINESS NAME AND LOCATION ADDRESS TAXPAYER NAME AND MAILING ADDRESS <br />Business Name Name <br /> Erika G Flores <br />Street Address Street or Other Mailing Address <br /> 327 Roush Lane <br />City ::state Zip Code City State Zip Code <br /> Grand Island NE 68801 <br />Tax <br />Category Tax Period Date of Amount of Tax Penalty Interest Additions Balance of <br />Number Assessment Assessment Due <br />22 2005 07/26/2006 4,951.00 327.55 806.71 6,085.26 <br /> TOTAL $ 6,085.26 <br />I hereb certi that the Nebraska De artment 0 Revenue has com lied with the revenue laws of the State of Nebraska in the determination of the <br /> <br />y ty 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 serve continue the lority of the s~te's interest in the affected property of the taxpayer. <br /> <br />sign <br />here <br /> <br /> <br />Revenue Agent <br />Title <br />Revenue Supervisor <br />Title <br /> <br />06/02/2008 <br />Date <br /> <br />308632-1200 <br />Telephone Number <br /> <br />06/02/2008 <br /> <br />Date <br />4-494-1974 Rev, 2-2002 Supersedes 4-494-1974 Rev. 10--1995 <br /> <br />~ <br />