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<br />09/22/2008 MON 14:47 FAX 402 471 4429 UCC SECRETARY OF STATE ~~~ Hall <br /> <br />141002/002 <br /> <br />Please forward to: <br />Nebraska Dept of Revenue <br />4500 Ave I PO Box 1500 <br />Scottsbluff, NE 69363-1500 <br /> <br />200808105 <br /> <br /> <br />~ <br /> <br /> <br />~ <br />IN.br...k. O_".,...,nl a# <br /> <br />~REVENUE <br /> <br />WWVl'."."...u..n..1JI!I...... <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 Federalldenlification Number <br /> 45439419 <br />Lien Serial Number Lien Filed With Social Security Number Spouse's Social Security Number <br /> 71730122 [lg Register of Deeds Dcounty Clerk 1914 <br />Date of Lien Lien Type County <br /> 09/18/2008 00 Original DContinualion o Corrected Hall <br />BUSINESS NAME AND LOCATION ADDRESS TAXPAYER NAME AND MAILING ADDRESS <br />Business Name Name <br /> Guadalupe Terrazas <br />Street Address Street or Other Mailing Address <br /> 1024 W 10th Street <br />City ;:state 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 />22 2005 03/09/2007 411.00 127.75 82.25 621.00 <br /> TOTAL $ 621.00 <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, d 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 t ntinue e prio' of the state's interest in the affected property of the taxpayer. <br /> <br />sign <br />here <br /> <br /> <br />Revenue Agent <br />Title <br /> <br />Revenue Supervisor <br />Title <br /> <br />09/18/2008 <br />Date <br /> <br />308 632-1200 <br />Telephone Number <br /> <br />09/18/2008 <br /> <br />Date <br />4-494-1974 Rev. 2-2002 Supersedes 4-494-1974 Rev. 10.1995 <br /> <br />v <br />