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11/30/2009 MON 14:33 FAX 402 471 4424 UCC SECRETARY OF STATE y-+~ Hall Id1002/004 <br />IIE tae ei Si^4a Jo1.n A tals -UCC S7L <br />200909449 <br />Please forward to: ~mssise0a-a PeS; t <br />cAaau~o RanoN sit <br />Nebraska Department of Revenue Filtd: 11/30/2009 08:5a RM <br />4500 Ave I PO Box 1500 <br />Scottsbluff, NE 69363-1500 <br />^ , N~ebr~aska Department of <br />REVENUE NOTICE OF STATE TAX LIEN <br />V1/1n/w. rave n u 4s. n e. g ov <br /> PLEASiw SNOT WRITB IN THIS SP E <br />This Notice of State Tax Llen is issued by the Nebraska Department of <br />Revenue for gnpald taxes gursuant tp the revenue laws pf the state'pf <br />Nebraska. Notice is herby given thattaxes~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~fotRreal~and~personal~prsperkywbelor+gin~ta•the.taxpayer~-~A- ,-~.-.-~.~.mmmr.,.-.-~,~,-.~:-:-...-n,M-~-~,~.~r-"-~.-~.,,.w,--~-,_--.,~ <br />or hereafter ac uired. <br />s Identification um F era denU canon umber <br />98411039 <br />Lien rial um Lien FU i ocia 'ty Number Spouse's ocial <br />5eatrity urrl <br />10932707 ®Register of Deeds ~Couniy Clerk XXX-XX-ag60 <br />Date o Lien ien Type <br />11/23/2009 ®Qriginal ~Continuadon ~Correded HALL <br />BU51NES5 NAME AND 4oCAT 10N ADDRESS TAXPAYER NAME AND AAAILING ADDREBS <br /> RAMON CABALLERO JR <br /> 2903 W STOLLEY PARK RD <br /> GRAND ISLAND NE 68803 <br />Tax <br />Category <br />Number Tax Period Data of <br />Assessment Amount of Tax Penally Interest Additions Balance of <br />Assessment Dua <br />22 2005 02/18/2009 961.00 48.05 174.91 1,183.96 <br /> <br /> <br /> <br /> TOTAL $ 1,183.96 <br />I hereby certif y that the Nebras ka t7epartment of Revenue has complied w l revenue laws a the State of Nehras a in the de temmnahnn nr the <br />amount shalom m be ,and the <br />effective lien, it serv Conti th <br />sign re rs ature <br />here - <br />Authorized Signature <br />der has failed to pay the amount due after demand. If this Notice of State lax Lien is an extension of an <br />(dority ti1e state's interest in the affected property of the taxpayer. <br />e <br />Revenue Agent 11/23/2009 (308)fi32-12pfi <br />itie a slephone umber <br />~' 11/23/2009 <br />Title Date <br />4-4941974 Rtv.1.2002 Supersedes 4,494.1874 Rev, 141995 <br />~: <br />i. <br />j: <br /> <br />