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<br />07/31/2008 THU 14:57 FAX 402 471 4429 UCC SECRETARY OF STATE ~~~ Hall <br /> <br />121003/004 <br /> <br />~ <br /> <br />NE S.." on st..... J..hn A Gal.. . ucc <br /> <br /> <br />9908567304-1 P9S; <br />CALDERON GUILLERMO M <br />Filed: 07/31/2009 10:59 AM <br /> <br />200806589 <br /> <br /> <br />:~ <br />IN...b.ti~kJii o..,._Nt oM"' <br />REVEN:UE <br /> <br />WWW.Ir._..nu...~.o....tDV <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 />--. Nebr~~~_II._~~!i~~.!s hereb~.~~~~n that tax~.s ~ncluding 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 Federal Identification Number <br /> 9028315 <br /> Lien Serial Number Lien Filed With (Isocial Security Number Spouse's Social Security Number <br />J ~ D08 CBK3 [&I Registar of Deeds Dcounty Clerk XXX-XX-3743 <br /> Date of Lien Lien Type County <br /> 07/25/2008 [&IOriginal DContinuation o Corrected HALL <br />I BUSINESS NAME AND LOCATtON ADDRESS TAXPAYER NAME AND MAILING ADDRESS <br /> Business Name Name <br /> GUILLERMO M CALDERON <br /> Street Address Street or Other Mailing Address <br /> 3612 CURRAN AVE <br /> City ::itate Zip Code City State Zip Code <br /> GRAND ISLAND NE 68803 <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 300.00 60.00 72.38 432.38 <br />12/31/2004 <br />01 01/01/2005~ 08/01/2006 375.00 75.00 67.97 517.97 <br />12/31/2005 <br />01 01/01/2006- 07/01/2007 470.00 94.00 56.35 620.35 <br />12/31/2006 <br /> TOTAL $ 1,570.70 <br /> <br />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 <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 serves to continue the priority of the state's interest in the affected property of the taxpayer. <br /> <br />sign <br />here <br /> <br /> <br />402 'f JI -.0f- <br />:~ ~ Da~ TelephJj V:bec <br />h) Lv~ 7 'JJ '$ <br />Titl Date <br />. 4-494-1974 Rev. 2-2002 SUPBnoBdsG 4-494-1974 Rev. 10-1995 <br /> <br />, (\\J <br />';1 ;\.j- <br /> <br />:;,,' 'I' <br /> <br />'," :.: <br />, <br /> <br />-I" <br />P .. i.,::"(t, <br />~' 11\\; <br />":.'~,,'Jt i,.~ <br />'~, ":", /' <br /> <br />"!' ';)<<,: <br />.~ ,"- j.',l'~, <br />