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<br />03/13/2009 FRI 13:09 FAX 402 471 4429 UCC SECRETARY OF STATE 444 Hall <br /> <br />1210061006 <br /> <br />200901863 <br /> <br /> <br />Dlb <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 ac uired. <br />Nebraska Identification Number Federal Identification Number <br />38695464 <br /> <br />lien Serial Number <br /> <br />Lien Filed With <br /> <br />Qg Register of Deeds <br />Lien Type <br />09/14/1999 OOriginai OOContinuation <br /> <br />BUSINESS NAME AND LOCATION ADDRESS <br />Business Name <br /> <br />991830033 <br /> <br />Social Security Number <br />DCounty Clerk XXX-XX-3325 <br /> <br />Spouse's Social Security Number <br /> <br />Date of Lien <br /> <br />County <br />o Corrected HALL <br /> <br />TAXPAYER NAME AND MAILING ADDRESS <br /> <br />Name <br /> <br />Street Address <br /> <br />RICHARD AMESQUITA <br />Street or Other Mailing Address <br />314 S ELM <br /> <br />City <br /> <br />ae <br /> <br />Zip Code <br /> <br />City <br /> <br />Tax <br />Category <br />Number <br /> <br />GRAND ISLAND <br /> <br />Slate <br />NE <br /> <br />Zip Code <br />68801 <br /> <br />Tax Period Date of <br />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 />1995 <br /> <br />05/18/1999 <br /> <br />945.00 <br /> <br />47.25 <br /> <br />273.32 <br /> <br />1.265.57 <br /> <br />TOTAL <br /> <br />$ <br /> <br />1,265.57 <br /> <br />I hereby certify that the Nebraska DepartmentOf 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 to continue the priority of the state's interest in the affected property of the taxpayer. <br /> <br />sign <br />here <br /> <br /> <br />402 471~5928 <br /> <br />Telephone Number <br /> <br />03/10/2-009 <br /> <br />Date <br />4-494-1974 Rev. 2.2002 Supersedes 4-494-1974 Rev. 10-1995 <br /> <br />~ <br />