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<br />07/30/2008 WED 15: 06 <br /> <br />FAX 402 471 4429 UCC SECRETARY OF STATE ~~~ Hall <br /> <br />1210021003 <br /> <br />r!P <br /> <br />200806566 <br /> <br />1111"11111' <br /> <br /> <br />9908567137-6 PSIS. <br />~~~~0?~~/2008 10:52 AM <br /> <br /> <br />~ <br />Neb......... D.,...,I'ln>i..r'it <0<1" <br />REVENlUE <br /> <br />w_ ........"l'tlf.lll!O....IiI<.'illg,... <br /> <br /> <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 />Nebraska. Notice is hereby given that taxes including penalties and <br />interest, which are shown below, are due 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 Federalldentitication Number <br />36591718 <br /> <br />Uen Filed With Social Security Number <br />00 Register of Deeds Dcounty Clerk XXX-XX-2132 <br />Lien Type <br />11/06/1998 o Original OOContinuation <br />BUSINESS NAME AND LOCATION ADDRESS <br />Business Name <br /> <br />Spouse's Social Security Number <br /> <br />Lien Serial Number <br /> <br />983100043 <br /> <br />Date of Lien <br /> <br />County <br /> <br />o Corrected HALL <br />TAXPAYER NAME AND MAILING ADDRESS <br /> <br />Name <br /> <br />Street Address <br /> <br />JOSE RAMIREZ <br />Street or Other Mailing Address <br />411 N LOCUST <br /> <br />GRAND ISLAND <br /> <br />State <br />NE <br /> <br />Zip Code <br />68801 <br /> <br />City <br /> <br />ae <br /> <br />Zip Code <br /> <br />City <br /> <br />Tax <br />Category Tax Period Date of <br />Number Assessment <br /> <br />Amount of Tax <br /> <br />Penalty <br /> <br />Interest <br /> <br />Additions <br /> <br />Balance of <br />Assessment Due <br /> <br />22 <br /> <br />1994 <br /> <br />09/22/1998 <br /> <br />1,264.00 <br /> <br />63.20 <br /> <br />405.17 <br /> <br />1,732.37 <br /> <br />TOTAL <br /> <br />$ <br /> <br />1,732.37 <br /> <br />t hereby certify that the Nebraska Department of Revenue has complied with the revenue laws of the Slate of Nebraska in the determination of the <br />amount shown to be due, and the taxpayer has failed to pay the amount due after demand. If this Notice of Slate Tax Lien is an extension of an <br />effective lien. it serves to continue the priority of the slate's interest in the affected property of the taxpayer. <br /> <br />sign <br />here <br /> <br /> <br />REVENUE AGENT <br />Title <br />R~ <br />Title <br /> <br />11J,S:.ft6 402471-5928 <br />Date I' Telep7~m~ <br /> <br />~ DZ I <br /> <br />~-49~'197~ Rev. 2-2002 Supersedes ~-49~-1974 Rev.1D-1995 <br /> <br />(}J <br />