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09/30/2005 16:45 FAX 14024714429 NEBRASKA Dee !gJ 002 o~ Ilr nebr;iska department of revenue ". " 200509784 Please Return Original Copy to the Nebraska Dept. of Revenue at 200 South Silber, North Platte, NE 69101 Notice of state Tax Lien PLEASE DO /'jO 99054U5152-9 P1l5' 1 MRRTI NEZ RRY R Filed: 09/30/2005 02,31 PM INDIVIDUAL INCOME TAX soc. SEC. NO. NEBR. IDENT. NO. SPOUSE SOC. SEC. NO. TAXABLE YEAR LIEN NO. COUNTY DATE OF NOTICE DATE OF ASSESSMENT 458656375 41116720 2003 051400020 HALL OS/20/2005 04/05/2005 RAY R MARTINEZ 518 E CAPITAL APT 13 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 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 HEREA~TER ACQUIRED. AMOUNT OF TAX . . . . . . . . . 293.00 PENALTY . . . . . . . . . . . . . .. -14. 65 INTEREST (COMPUTED TO OS/20/2005) 19_27 TOTAL AMOUNT DUE . . . . . . . . 326.92 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 DUEl 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~P;J: .C)~-2 . ~ .o.~ ...... ~~AR~' SIG T ~~~L~_._~~~:....._..... AUTHOR] TI~~ CJ:u 11S:. / Ga8)53.5.=-~ 29~ DATE/TELEPHONE .. .7.'-9?~~..... DATE ~. /1i7570/O'f