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<br />07/31/2008 THU 14:57 FAX 402 471 4429 UCC SECRETARY OF STATE ~~~ Hall <br /> <br />& <br /> <br />121002/004 <br /> <br />ST~ <br /> <br /> <br />200806588 <br /> <br />,~ <br />NWobt."'kll' D*Wi__m: elf <br />:REVENiUE <br /> <br />w"'"'w.....w.",u..u...'lI_ <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 pursuant to the revenue laws of the state of <br />Nebraska. Notice Is hereby given that taxes including penalties and <br />"-interest, which"are showrl'l,elow,are dueHfron, -the taxpayer'-s'pecified <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 /> 9463739 <br />lien Serial Number Lien Filed With Social Security Number Spouse's Social Security Number <br />1~oce(Ml( ~ Register of Deeds OCounty Clerk XXX-XX-9728 <br />Date of Lien Lien Type County <br /> 07/25/2008 OOOriginal DContinuation o Corrected HALL <br /> BUSINESS NAME AND LOCATION ADDRESS TAXPAYER NAME AND MAILING ADDRESS <br />Business Name Name <br /> JUAN JOSE PINEDA <br />Street Address Street or Other Mailing Address <br /> 208 W 5TH ST <br />City :::Itate 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 />01 01/01/2004- 08/01/2005 165.00 60.00 48.26 273.26 <br />12/31/2004 <br />01 01/01/2005- 08/01/2006 300.00 60.00 54.38 414,38 <br />12/31/2005 <br />01 01/01/2006. 07/01/2007 375.00 75.00 44.96 494.96 <br />12/3112006 <br /> TOTAL $ 1,182,60 <br /> <br />, hereby certIfy that the Nebraska Department of Revenue has compiled wIth the revenue laws of the State of Nebraska In the determlnatron of the <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 selVes to continue the priority of the state's interest in the affected property of the taxpayer. <br /> <br />402 '171'-5' 'Jrf <br /> <br />T...trs~~ J{;oj~ <br /> <br />Till . Date I <br />-,,,..... ,.'" __. "'-.-,,,, R... ,. '''' <br /> <br />sign <br />here <br /> <br /> <br />& <br />