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t)1/08/2Q10 FRI 13:55 FAX 402 471 4429 UCC SECRETARY pF STATE -+~~ Hall <br />b~ <br />2oiooo223 <br />~ooz/oo3 <br />. utc scaN <br />N~ Ssa of Sl~k~ John A Owl• <br />g9'1061t3190^3 Pss: i <br />RAMOS APOLLO L <br />Filed: 01/09/2010 10.00 AM <br />irdleFYnti~eko ®(Kpvrr[6'mOAti+dr <br />E''~'rE(t~E NQ I TATE TAX LIEN <br />C~'1~ o ~ <br />PLEASE DO NOT WRITE IN THIS SPACE <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 #hat 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 />Nebraska Identification Number Federal Identificatia <br />41003225 <br />Number <br />t7019fi0257 QRegtster of beads ~Counry Clerk XXX-XX-0644 <br />Data of Lien Lien Type County <br />08/23/2000 Original ^X Continuation Corrected HALL <br />BUSINESS NAME AND LOCATION ADDRESS TAXPAYER NAME AND MAILING ADDRESS <br />ApoLLO L RAMOs <br />or Ot er Mailing Address <br />1218 S LINCQLN <br />C~RANn ifil ANi7 NF aaani <br />Tax <br />Category Tax Period Date of Amount of Tax Penalty Interest Additions Balance of <br />Number Assessment Assessment Due <br />22 I 1995 105/2512000 I 242.00 I 60.50 I 94, 54 I I 397.44 <br />22 I 1996 105/2512000 ~ 861.00 I 21525 I 260.28 I I 1,336.53 <br />Please return Copy to: <br />Nebraska Dept of Revenue <br />PQ Box 94818 <br />Lincoln NE 68509 <br />TOTAL I $ 1,733.97 <br />~ namwy czruiy u~a: urn rveurd,Ka uepanmenr or Kevenua nos compuea warn me revenue laws at the State of Nebraska in the determination of the <br />amount shaven to be due, and the taxpayer has failed to pay the amount due after demand. If this Natice of State Tax Lien is an extension of an <br />effective lien, it serves to continue the priority of the state's interest in the affected property of the taxpayer. <br />REVENUE AGENT 01/05/2010 402 471-5928 <br />sign Preparer's Signature Title Date Telephone Number <br />here ~ REVENUE AGENT SUPERVISOR 01/05!2010 <br />A arized Signa re Title pate <br />4-484.1974 Rev. 2-2002 Supersedes 4^494-1974 Rev. 1o-i895 <br />~~' / <br />;\ %: <br />