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<br />08/12/2008 TUE 14:48 FAX 402 471 4429 UCC SECRETARY OF STATE ~~~ Hall <br /> <br />1210031003 <br /> <br />db <br /> <br />N& See er :ihie John A Gele . Ul;o; :iTL <br /> <br />Please forward to: <br />Nebraska Dept of Revenue <br />.4500 Ave I PO Box 1500 <br />Scottsbluff, NE 69363-1500 <br /> <br />200806973 <br /> <br /> <br />9908568232-9 PIlS; 1 <br />REYES FERNRNDO D <br />Filed: 08/12/2008 10;10 RM <br /> <br /> <br />~ <br />N.b.....klll, O_rtnwlm al <br /> <br />,REVENUE <br /> <br />www.........I'10111.. n... "'....... <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 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 /> 34734813 <br />Uen Serial Number Uen Filed With (ISOClal Security Number Ispouse's Social Security Number <br /> 81650018 00 Register of Deeds DCounty Clerk XXX-XX-7434 XXX.XX.7659 <br /> . <br />Date of Lien Uen Type County <br /> . 08/08/2008 1!I0rfginal DContinuation o Corrected Hall <br />BUSINESS NAME AND LOCATION ADDRESS TAXPAYER NAME AND MAILING ADDRESS <br />Business Name Name <br /> Fernando D & Patricia J Reyes <br />Street Address Street or Other Mailing Address <br /> 201 W 7th Street <br />City titate Zip Code City Stale 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 2006 01/15/2008 2,150.00 676.66 257.83 3,084.49 <br /> TOTAL $ 3,084.49 <br />I hereb certi that the Nebraska Department of Revenue has complied with the revenue laws of the State of Nebraska in the determination of the <br /> <br />y fy <br />amount shown to be d <br />effective lien, it serve <br /> <br />sign <br />here <br /> <br />... <br />.. <br />Authorized Signature <br /> <br /> <br />Revenue Agent <br />Title <br /> <br />Revenue Supervisor <br />Title <br /> <br />08/08/2008 <br />Date <br /> <br />308 632-1200 <br />Telephone Number <br /> <br />08/08/2008 <br /> <br />Date <br />4.<194-1974 Rev. 2.2002 Sljper5edes 4.<194-1974 Rev. 10-1995 <br /> <br />~ <br />