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12/04/2D09 FIt2 14:33 FAR 402 471 4429 UCC SECRETARY pF STATE yyy Hall <br />Please forward to: '~` ~ O J 0 9 5 7 9 <br />Nebraska Department of Revtrnue <br />4500 Ave I PO Box 1500 <br />Scottsbluff, NE 69363-1500 <br />I~p~2/002 <br />NE Ste pP Sbia .john R Oala -UCC STL <br />9809613418-7 Pga~ 1 <br />NGUYF.N KEVIN <br />Fl led: 12!0412009 08:38 f1M <br />Nebraska bepartment of <br />REVENUE .NOTICE 4F STATE TAX LIEN <br />www.revanue-ne.goV <br /> P E DO NpT WRITE IN T S A <br />This Notlce 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 properly belonging to the taxpayer <br />or hereafter ac wired. <br />N ra catKxt umtrer Fade anti Gabon Number <br />36363189 <br />lien nal Numt~er en i ad With al my Number Spouse's Sacaal Security Numtrer <br />10933167 ®Regis6ar of Deeds County Clerk XXX-XX-~i004 <br />Date of ien en Type my <br />12/02/2009 ®tJriginal.^Contirwation ~Corre~ted HALL <br />8U51NESS NAME AND LOCA TIQN ADDRESS. TAXPAYER NAMt: AND MAILING ADDRESS <br /> KEVIN NGUYEN <br /> 2404 W 13TH <br /> GRAND 15LAND NE 68803 <br />ax <br />Category <br />Number Tax Period Date of <br />Assessment Amount of Tax Penalty Interest AddMions Balance of <br />Assessment Due <br />22 2007 05/23/2008 289.D0 44.00 59.04 392.04 <br /> <br /> <br /> <br /> <br /> TOTAL $ 3s2.Da <br />I hereby certify at the/N~e as <br />8mOL91t Shown t0 t)B -1J8. end t ks Department <br />he taxnaver has f Revenue has complied with the revenue laws the fate of Nebraska in the deteirrdnadon of the <br />ailed to ruav fha amru~ni rli is a(Far riomsnri If ride Nw:..e ~P a~~~e re.. ~ :e..:e e......w.....~.....s .... <br /> <br />effective lien, it wnGnueit the~rity the state'sthe state's interest in the affer~ed property of <br />~ Revenue Agent <br />sign sue <br />here - Revenue Su ervisor <br />i re Title <br />thetaxpayer. ----- - ----- -- - --~.._._.. _. ~. <br />12/02%2009 (308)832-1208 <br />Date Telephone um <br />12/02!2009 <br />Date <br />1491-0971 Rev. 2-2002 Supersedes 4-48,41874 Rev.10.1995 <br /> <br />