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01/08/2010 FRT 13:55 FAX 402 471 4429 UCC SECRETARY OF STATE ~~~ Ha11 <br />~~ <br />20100022 <br />Please forward to. <br />Nebraska Department of Revenue <br />4500 Ave T PO Box 1500 <br />Scottsbluff, NE b93~3-1500 <br />X003/003 <br />N@ Sae ei Siwle John p 6ele -UCC ST4 <br />9810616221-® pg57 t <br />TREJO JUSTIN R <br />Ft led: 01/08/2010 10:42 pA1 <br />Nebraska l7epartment of <br />REVENUE NOTICE OF STATE TAX LIEN <br />www.revenue.ne-®ov <br /> PLEA E DO NOT I IN THI SPAC <br />This Notice of State Tax Llen is issued by the Nebraska Department of <br />Revenue for unpaid #axes 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 property belonging to the taxpayer <br />or hereafter ac wired. <br />Nebraska (denfification um er Federal I b capon umber <br />45596417 <br />Lien Serial Number Lien sled Wi Sara Security Number Spouse's Social Security Number <br />11034129 ®Register of Deeds County Clerk XXX-XX-0521 <br />Date of ien Lien Type County <br />01/05/2010 ®Original ~Cantinuation ~Correded HALL <br />BUSINESS NAME AND LOCA TION ADDRESS TAXPAYER NAME AND MAILINCr ADDRESS <br /> JUSTIN R TREJO <br /> 1212 N SYCAMORE <br /> GRAND ISLAND NE 68801 <br />ax <br />Category Tax Period Date of Amount of Tax Penalty Interest Additions Balance of <br />Number Assessment Assessment Dus <br />22 2006 Da/12/2009 661.00 32.55 122.31 805.86 <br /> <br /> <br /> <br /> <br /> TOTAL $ so5.as <br />I hereby certl that the Nebras ka Department o Revenue has mmnlit>d w ith Ihw rPVFy'urP law s of rhP S}ata of Nahraaka in tYw rl alarminafinn of Hic <br />amount shown to be due, and the taxpayer has fai ~ to pay the amount due after demand. If this Notice of State Tax Lien is an extension pf 0n <br />effectiv~ien, es to oontinu th n ry of t state's interest in the afferaed property of the taxpayer. <br />y Taxpayer Services Specialist II 01/05!2010 (308)632-1200 <br />Sl~n r i ur Title Date elephane umber <br />here ^ Revenue $u ervisor 01105/2010 <br />horized lure Tide Date <br />4.494.1074 Rev.2.2002 Supersedes 4.494.1974 Rev.10.7Be5 <br /> <br />