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09/25/2008 THU 14:16 FAX 402 471 4429 UCC SECRETARY OF STATE ~~~ Hall 14J002/002 THIS NOTICE OF STATE TAX LIEN IS ISSUED BY THE NEBRASKA DEPARTMENT OF REVENUE FOR INDIVIDUAL INCOME TAX PURSUANT TO THE REVENUE LAWS OF THE STATE OF NEBRASKA. NOTICE IS HEREBY GIVEN THAT INDIVIDUAL INCOME TAXES INCLUDING PENALTIES AND INTEREST, WHICH ARE SHOWN BELOW ARE DUE FROMTF~ TAXPAYER SPECIFIED ABOVE 'AND REMAIN UNPAID AFTER DEMAND. THESE TAXES CONSTITUTE -ALIEN IN THE COUNTY FOR PROPERTY BELONGING TO THE TAXPAYER OR HEREAFTER ACQUIRED. AMOUNT OF TAX . . . . . . . . . . . . 504.00 PENALTY . . . . . . . . . . . . . . . . . . 25.20 INTEREST (COMPUTED T<; ~.J4/2007) . . . . . I ~/. <<(,- UNDERPAYMENT OF ESTIMATED TAX PENALTY . . . 0.00 TOTAL AMOUNT DUE . . . . . . . . . . . . . ~-'_" I H~REBY CERTIFY THAT THE NEBRASKA DEPARTMENT OF REVENUE HAS COMPLIED WITH THE REVENUE LAWS OF THE STATE OF NEBRASKA IN THE DETERMINATION OF THE AMOUNT SHOWN TO BE DUE, AND THE TAXPAYER HAS FAILED TO PAY THE :,~::::::::::,::::::::;::::f.ij:::::c:::;:'AMQUN'D:,'J~:UEt::~AE5J:"-ER:~'L)EMbNnh,::,,",:',:,,:~~,:::W..H~t.'S'::i,,'N~~'I:~:i:,,"'_~_~:',,:~,1~~~,,'~~~:::'~i,~~=~,::t=$;'O':~;::~:=-:::::=_'=::~:;:. =~:::::~ EXTENSION OF AN EFFECTIVE LIEN IT SERVES TO CONTINUE THE PRIORITY OF , : THE STATE'S INTEREST IN THE A~FECTED PROPERTY OF THE TAXPAYER. 9/!. 1jQ.~. / .Jqt.-.'.~~~/~ DATE/TELEPHONE . .r!fA f . . . . . . . . DAf;' f-- /lT1S 10104 6\ _r nebraska department of revenue IWllrllmrllll1 9908571682-7 pss: 1 CHAVEZ BOLANOS 05"lN Filed: 09/25/2008 11:13 AM 200808195 NEBRASKA DEPT OF REVENU 4500 AVENUE I PO BOX 1500 SCOITSBLUFF, NE 69363-1500 Notice of state Tax Lien ,PLEASE DO NOT WRITE IN THIS SPACE INDIVIDUAL INCOME TAX SOC. SEC. NO. NEBR. IDENT. NO. SPOUSE SOC. SEC. NO. TAXABLE YEAR LIEN NO. COUNTY DATE OF NOTICE DATE OF ASSESSMENT 0375 43165699 2004 072010295 ijALL 07/20/2007 05/08/2007 OSMIN CHAVEZ BOLANOS 4505 19TH ST APT C1 COLUMBUS NE 68601 .~.~....... TI E TITLE