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01/07/2005 12:46 FAX 14024714429 NEBRASKA UCC <br />I A I �,� <br />Li <br />Or <br />nebraska <br />department <br />of revenue <br />200500210 <br />IM 003/006 <br />ra Soo of 541.4s - t1CC STL <br />I <br />9905370497 -5 Pas: 1 <br />PUENTE JOHN S <br />Filed- 01106/2005 04:12 PM <br />Notice of State Tax Lien <br />PLEASE DO NOT WRITE IN THIS SPACE <br />Sacs SEC#.NG& 5069647:24 <br />NE .# IRENTa,WO4 2333304 <br />PUME.SoC# SEC: o* <br />TAXABLE ' YEAR 23 <br />LSE 4 042260651 <br />cc <br />JUNTY HALL JOP414 S P.i_T <br />DATE , OF NOTICE 08013/2004: 3122 w 'C' �E St-t; AFT.47 <br />DATED ASSES ENT 05Y25/20ID4 GRAM 'JULAFM NE 68-803 <br />THIS NOTICE OF STATE TAX .LIEN IS ISSUED ST THE l _8?AS : DEPART*EN CW <br />RE VEHM FOP ' FADMDU L 114C TAX 'P SUART TO T WE -REVENUE, LAWS . O T <br />STATE OF . 'RI.A£KAa NOTICE TS €REBY GIVEN- THAT l*DIVIDUAL INCUW <br />TAXES TNCL ING PENALTIES A10- ;NTEREST1 MfilCH. A; 5HtWll%.' . APr <br />FR THE TAXPAYER SPFCTF.TED ANI A E ' ` # i"AT = A'€A �• <br />THESE' TAXI CCW'`3iTU A:...C.s ' IN`:IW COUNTY FOR PRUPERTY. BELONGING TC <br />THE TAXPAYER G ' REAFT ' AMIMBS <br />ANDUPIT KE <br />OF ` TA <br />PENALTY #' • i S ! i • >f # s 4 i f ! 0 i # 0 s IW 0 L i i �t8 <br />INTEREST (CWWl6—xED TO 08/2­�­/201044) 2001,60 <br />TaTAL APOUNT DUE 547-70 <br />i HEMY'CERTIFY THAT T E NEBRASKA DEPART Wo GF REVENM HAS Ccl"PLTFD <br />Tfi THE HE - kEVENUE DNS -01F I THE STATE OF MES AS ' I : THE DETMI iTION r-vr- <br />THE AMOUNT SHOWN TO, BE DMl AND THE TAXPAYER NAS FAILED , TU PAY T"I"C <br />AMULWT Dg AFTER' DEMANt�.,i' a IF-THIS' NOTICE DF ST.ATE TAX LIEN' IS AN <br />EXTENSION OF AN EFFFECTIVEE'LIEN'IT SERVES TO CONTINUE THE PRTFUATTY OF <br />THE STATE'S I TEREST T : T 1E AFFECTED PROPERTY 0W T iM TAXPAYERW <br />• #'/� Ii�s #��+a sss #• / ,si•i •ss <br />PR ER* S KAT'U. T17LB 1 <br />04ir040a4s04YS +4fia.s0 00004 alp 4 #+!434'00 <br />AUTHORIZED SIGNAIM'E T ITL <br />NEBRASKA DEPARTMENT OF REVENUE - White and Canary Copies <br />Pmtad wfhsov Ink on reovdad Paper <br />DATE/TrELEP-RONE a0'lf40 f. <br />s #044 #44 s #+`+• 0400 #, / �" <br />DATE <br />TAXPAYER - Pink Copy <br />7 -145 -1979 Rev. 2 -2000 Supersedes 7- 145 -1979 Rev- 10-1995 <br />