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11/20/2009 FRY 14:43 FAX 402 471 4429 UCC SECRETARX OF STATE ~~~ Hall <br />Please forward to: <br />Nebraska Department of Revenue <br />4500 Ave T PO Box 1500 <br />Scottsbluff, NE 69363-1500 <br />20090923/ <br />~002/p02 <br />NE Src qi 5keke Jalm A Galr -UCC 5TH <br />9909612547-3 --- ---pgs ' 1 "' <br />WERNANDteT NERI JR <br />Filed: 11/20/2009 08;51 AM <br />Nebraska Department of <br />REVENUE NOTICE QF STATE TAX LIEN <br />VVWVY.revertUw.rte.apV <br />This Natice of State Tax Lisn is Issued by the Nebraska pepartment of <br />Revenue for unpaid taxes pursuant_to the revenue laws of the state of <br />Nebraska.Notice is hereby givt'n 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 acquired. <br />43282857 <br />10932456 ®Register of Deeds County Clerk XXX-XX-1754 <br />Date of Uen Den ype ty <br />11/18/2DD9 ®Original. ~Cantirtuatlan Corrected HALL <br />BUSINESS NAME AND,LOCATION ADDRESS TAXPAYER NAME AND MAILING ADDRESS <br />NERI HERNANDEZ JR <br />132D N OAK ST <br />GRAND ISLAND NE 68801-3858 <br />Gatagory Tax Period Deta of Amount of TeX Penalty Interest Additions Balance of <br />Numher Arsessmpnt Assessment Due <br />22 2008 08/05/2009 1,086.OD 8D.88 32.28 1,199.16 <br />TOTAL $ 1,199-18 <br />i hereby certify that the ebrdska Departrnent of Revenue has compli with the revenue laws of the State of Nebraska in the determination of e <br />amount shown to be ,and the taxpayer has failed to pay the amount due after demand. If this Notice of State Tax lJen is art extension of an <br />effective lien, it to corlGnue riarity of the state's interestln the affected property ofttre tat~yer. <br />^ Revenue Agent 11/18/2009 (30832-12013 <br />S Ig rl P s e i e Date ephone Number <br />here ^ ~ _Reven_ue Supervisor 11/18!2009 <br />Signature Title ". ."`..-"'- pie <br />4.494-1974 Rsv, 2.2002 Supv~ada 4494-1874 R~v,1at996 <br />V { <br />