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01/15/2010 FRI 15:06 FAX 402 471 4429 UCC SECRETARY OF STAYS a-+y Ha11 <br />fdlooz/ooz <br />`) N! ire e1 iu~r JeMn R 6a1^ - uC[ STL <br />2 010 0 0 3 71 gg1061B934-9 Ppa: 1 <br />MERCLIDO RAFriF~l.it <br />Filed: 01/15/2010 12:48 PM <br />Nebraska Department of <br />REVEN~E NOTICE OF STATE TAX LIEN <br />www.revenua.ne.gov <br /> L 5E DO NO 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 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 uired. <br />Nebraska IdenUficaUon Number F eral Idenlificaiion Number <br />39165892 <br />Lien Serial Number Lien Filed With So Secunry umber pouse"s octal ecurity Number <br />11034781 ®Register of Deeds County Clerk XXX-XX-8012 XXX-XX-8812 <br />Date of lien Lien Type County <br />01/12/2010 ®Original [IContinuation Corrected I1ALL <br />BUSINESS NAME AND LOCA TIpN ADDRESS TAXPAYER NAME AND MAILING ADDRf:55 <br /> RAFAELA & ELIAZAR M MERCADO <br /> 3400 CAMPBELL ROAD APT #305 <br /> WOUSTON TX 77080 <br />ax <br />Category Tax Period bate of Amount of Tax Penalty Ir-terest Additions Balance of <br />Number Assessment Assessment Due <br />22 2006 05/12/2009 243.57 21.31 34.79 299.67 <br /> <br /> <br /> <br /> <br /> TOTAL $ 299.67 <br />I hereby certif y that the Nebras ka lkoartment of Revenue has complied w ith the revenue law s o the Stale of Nehraska in the d etelminalinn of Ihw <br />amount shown to be due, and the taxpayer has failed to pay the amount due after demand. If this Notice of State Tax Lien is an extension of an <br />effective lien, it serve to continue the priority of the state's interest in the affected property of the taxpayer- <br />Revenue Agent 01/12/2010 (402171-5928 <br />sign Pre are s igna ure iUe Date elep vne Numher <br />h@tt? ^ ~ Revenue Supervisor 01/12/2010 <br />A prized Signature Title ~' Date <br />4i94.197~ Rev. 2do112 Supersedes ~-I9q-197 Rev. ta1995 <br />\~ <br />