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<br />10/21/2008 TUE 14:55 FAX 402 471 4429 UCC SECRETARY OF STATE ~~~ Hall <br /> <br />1210021004 <br /> <br />Please forward to: <br />Nebraska Dept of Revenue <br />4500 Ave I PO Box 1500 <br />Scottsbluff, NE 69363-1500 <br /> <br />200808917 <br /> <br />'I~ "1"'1"111" III! <br /> <br /> <br />9908573875-8 Pes: 2 <br />LAGUNA FELIPE <br />Filed: 10/21/2009 11 :40 AM <br /> <br />rjJ <br /> <br /> <br />~ <br />iN'tIIbr"'....II. D~1'lt a# <br /> <br />iREVENUE <br /> <br />.....""'...... f'. "'......... .....u.'" <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 /> 38763303 <br />Lien Serial Number Lien Filed With Social Security Number Spouse's Social Security Number <br /> 991690142 00 Register of Deeds Ocounty Clerk XXX-XX~2741 <br />Date of Lien Lien Type County <br /> 09/10/1999 ' OOrlginal I!IContinualion o Corrected Hall <br />r BUSINESS NAME AND LOCATION ADDRESS TAXPAYER NAME AND MAIUNG ADDRESS <br />Business Name Name <br /> Felipe Laguna & L Andrade Rodriguez <br />Street Address Street or Other Mailing Address <br />.' 212 N Darr <br />City ::>>late 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 /> 22 1995 04/29/1999 1,062.57 53.13 303.66 1,419.36 <br /> TOTAL $ 1,419.36 <br />I hereb certi that the Nebraska De artment of Revenue has com lied with the revenue laws of the State of Nebraska in the detennination of the <br /> <br /> <br />p p <br />s failed to pay the amount due after demand. If this Notice of State Tax Uen is an extension of an <br />of the state's interest in the affected property of the taxpayer. <br /> <br />sign <br />here <br /> <br />Revenue Agent <br />Title <br /> <br />Revenue Supervisor <br />Tille <br /> <br />10/16/2008 <br />Date <br /> <br />308 632-1200 <br />Telephone Number <br /> <br />10/16/2008 <br />Date <br />~.ol94.1974 Rev. 2.2llO2 Supersedes 4-494-'97~ Rev. 10-1995 <br /> <br />SEE ATTACHMENTS V <br />