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<br />01/21/2009 WED 15:20 FAX 402 471 4429 UCC SBCRETARY OF STATE ~~~ Hall <br /> <br />121002/005 <br /> <br />otQ <br /> <br />200900375 <br /> <br />'111 rrllmrrr IIll <br /> <br />9909584261-2 Pes: 1 <br />RODRIQUEZ ALVARO <br />Filed, 011211200902:17 PM <br /> <br /> <br />~ <br />N;o.br,!lI>$k"; O..,p"'''lJiIW'r't olf <br /> <br />. :REVE!NiUE <br /> <br />'.\lWW _lI''''''''...f1iUi....'r....;Q10V <br /> <br /> <br />HIS SPACE <br /> <br />This Notice of State Tax Lien is issued by the Nebraska Department of <br />. Revenue for unpaid taxes pursuant to the revenue laws of the state of <br />Nebraska. Notice is hereby given that taxes including penalties and <br />interest, which are shown below, are due from the taxpayer specified <br />below and remain unpaid after demand. These taxes constitute a lien <br />in the county for real and personal property belonging to the taxpayer <br />or hereafter ac uired. <br />Nebraska Identification Number Federal Identification Number <br />40999130 <br /> <br />Lien Filed With <br /> <br />I:&! Register of Deeds <br />lien Type <br />05/14/1999 DOriginal I:&!Continuatlon <br /> <br />BUSINESS NAME AND LOCATION ADDRESS <br />Business Name <br /> <br />991340351 <br /> <br />Social Security Number <br />DCounty Clerk XXX-XX"0849 <br /> <br />Spouse's Social Security Number <br />XXX-XX-3206 <br /> <br />Lien Serial umber <br /> <br />Date of Lien <br /> <br />County <br />Dcorrected HALL <br /> <br />TAXPAYER NAME AND MAILING ADDRESS <br /> <br />Name <br /> <br />Street Address <br /> <br />ALVARO RODRIGUEZ & M SANTACRUZ <br />Street or Other Mailing Address <br />108 W 9TH ST <br /> <br />GRAND ISLAND <br /> <br />State <br />NE <br /> <br />Zip Code <br />68801 <br /> <br />City <br /> <br />ae <br /> <br />Zip Code <br /> <br />City <br /> <br />Tax <br />Category Tax Period Date of <br />Number Assessment <br /> <br />Amount of Tax <br /> <br />Penalty <br /> <br />Interest <br /> <br />Additions <br /> <br />Balance of <br />Assessment Due <br /> <br />22 <br /> <br />1996 <br /> <br />02/11/1999 <br /> <br />248.00 <br /> <br />62.00 <br /> <br />46.35 <br /> <br />356.35 <br /> <br />TOTAL <br /> <br />$ <br /> <br />356.35 <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 0 continue e priority of the state's ,interest in the affected property of the taxpayer. <br /> <br />sign <br />here <br /> <br /> <br />EVENUE AGENT <br />Title <br /> <br />01/15/2009 <br />Date <br /> <br />402471-5928 <br />Telephone Number <br /> <br />REVENUE AGENT SUPERVISOR <br />Title <br /> <br />01/15/2009 <br />Date <br />4-494-1974 Rev. 2.2002 Supersedes 4.494-1974 Rev.1Q-1995 <br /> <br />(j? <br />