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<br />01/21/2009 WED 15:21 FAX 402 471 4429 UCC SECRETARY OF STATE ~~~ Hall <br /> <br />l2I004/005 <br /> <br />fo <br /> <br />200900377 <br /> <br />1111111111' <br /> <br />9909584263-6 pg$. <br />NZALEZ REVr\UNDO <br />~~led: 01/21/2009 02:17 PM <br /> <br /> <br />~ <br />IN...b.......k.. ;:;i_'lIrr,m>l,O'~t;a~ <br /> <br />IREVEiN!UE <br /> <br />'tNwW ..'......."'r""" c.'. i.....,i:Ii(J,y lKC. <br /> <br />G <br /> <br />NOTICE OF STATE TAX LIEN <br />qqqq m 7IP?,. <br />'1"'1 ~ <br />PLEASE DO NOT WRITE IN THIS SPACE <br /> <br /> <br />This Notice of State Tax Lien is issued by the Nebraska Department of <br />Revenue for unpaid taxes pursuant to the revenue laws of the state of <br />Nebraska. Notice is hereby given that taxes including penalties and <br />interest, which are shown below, are due from the taxpayer specified <br />below and remain unpaid after demand. These taxes constitute a lien <br />in the county for real and personal property belonging to the taxpayer <br />or hereafter ae ulred. <br />Nebraska Identification Number Federalldentitication Number <br />37315900 <br /> <br />991830029 <br /> <br />Lien Flied With <br />[lgRegisler of Deeds <br />lien Type <br />DOriQinal l:&IConlinualion <br /> <br /> <br />Spouse's Social Security Number <br /> <br />lien Serial Number <br /> <br />07/02/1999 <br /> <br />XXX-XX-5184 <br />County <br />DCorrected HALL <br />TAXPAYER NAME AND MAILING ADDRESS <br /> <br />Date of lien <br /> <br />BUSINESS NAME AND LOCATION ADDRESS <br />Business Name Name <br /> <br />Street Address <br /> <br />REYMUNDO GONZALEZ <br />Street or Other Mailing Address <br />217 E 5TH <br /> <br />GRAND ISLAND- <br /> <br />State <br />NE <br /> <br />Zip Code <br />68801 <br /> <br />City ae Zip Code <br />Tax <br />Category Tax Period' Date of Amount of Tax <br />Number Assessment <br />22 1995 05/18/1999 860.00 <br /> <br />City <br /> <br />Penalty <br /> <br />Interest <br /> <br />Additions <br /> <br />Balance of <br />Assessment Due <br /> <br />43.00 <br /> <br />248.74 <br /> <br />1,151.74 <br /> <br />TOTAL <br /> <br />$ <br /> <br />1.151.74 <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 />REVENUE AGENT <br />Title <br /> <br />01/15/2009 <br />Date <br /> <br />402471-5928 <br />Telephone Number <br /> <br />REVENUE AGENT SUPERVISOR <br />TiUe <br /> <br />01/15/2009 <br /> <br />Date <br />4.494.1974 Rev. 2.2002 Supersedes 4-494.1974 Rev.l0.199S <br /> <br />@ <br />