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07/22/2009 WLD 15:06 FAX 402 471 4429 UCC SECRETARY OF STAT)3 ~-~~ Ha11 <br />~~ <br />e. .. <br />Please forward to: ~ ~ ~ 9 ~ s ~ 2 3 <br />Nebraska Department of Revenue <br />4500 Ave I PO Box 1500 <br />Scottsbluff, NE 693G3~1500 <br />f~ao4/oo5 <br />NE Sic at Sbf•a Jehn rJ Garo - 4C[ STL <br />9909602746-3 Pos; 1 <br />Filed~z07~22 2009 09:02 AM <br />N~ ska Department of <br />REVENUE NOTICE OF STATE TAX LIEN <br />www.revenus.na.gov <br /> PLF,ASE b T IN I PA <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 far real and personal property belonging to the taxpayer <br />or hereafter ac uired. <br />Nebraska Identlficatian Nurrd~er Federa en' don rxntx~ <br />37952706 <br />Lien 5enal rxnbei• Lien filed With Sop Securi umber pause's Soaal ty umtx;r <br />091630283 ®Register f>f Deeds County Clerk XXX-XX-0541 <br />Dace Lien uen Type my <br />07/17/2009 ®OriginalContinuation _ ^Carrected HALL <br />BUSINESS NAME AND LgGA TION ADDRESS TAXPAYER NAME AND MAILING ADDRESS <br /> LEOPOLDO BENITEZ <br /> 311 N LINCOLN AVE APT 4A <br /> GRAND ISLAND NE 68801.4776 <br />Tax <br />Category Tax Period bete of Amount of Tax Penalty Interest Addltlons eatance of <br />Number Assessment ~ Assas>:mant Due <br />$2 X007 06112/2009 429:OD 21.45 36x78 486:53 <br /> <br /> <br /> <br /> <br /> TOTAL $ 486.53 <br />I hereby certify flat the Nebras ka ent of Revenue has Dorn with a revenue laws of the Slate of elxaska in determination a <br />2m0urlt ShaNRi to be due. and t he talmaver haS f ailed ~ eav Mre amount due after demand.. If f hiR Nntirp of .^,fafp Tar I iPn is an wYfr Heim of an <br />effective lien, it serves to ntlnue the priority of the state's interest iri the affected property of Ore taxpayer. <br />rJ Revenue Senior Agent 07/17/2009 (305)632-1205 <br />sign P s - I e Date Number <br />here ^ Revenue Supervisor 07/17/2008 <br />orized ignature Title- ~ ~~ ~~ ~~.~~ Date <br />4-49q-1874 Rtv. 2.2002 Supersedes 4-4SM-1974 Rer.1a1995 <br /> <br />