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09/03/2010 FRZ 15:02 PAX 402 471 4429 UCC SECRETARY pF STATE ~yy Hall <br />b~ <br />201006359 <br />~D04/004 <br />NE 5.c of S~~le Jvl.n A 6.Ie UCC ST4 <br />9910638458-7 pgs; 1 <br />GUTIERREZ SERGIO <br />Filed; 09/03/2010 11:41 AM <br />N+eibrrsk~ IQrar:rlrn.6nt o{ <br />I~E'1~ir'EI~E NOTICE OF STATE TAX LIEN <br />~wrWMV.r ~svi-n~ir., na..Arav <br />...-_-._.....Revenuelforoun a d t x .-~Ten~~~ uant tom::~:~.~.- .::.....::.::.:.:::~.:.~-_ ___-:~.:..:::_. <br />issued by the Nebraska Department of <br />p es pure 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 acquired. <br /> 10188$00 <br />Lien Serial Number Lien Filed Ith octal ecurity umber Spouse's Social Security umber <br />J ~ ~ Register of Deeds ~Gounty Clerk XXX-XX-1006 <br />Data of Lien Lien Type ounty <br /> 08/31/2010 QX Qriginal Continuation Corrected Hell <br /> BUSINESS NAME AND LOCA TION ADDRESS TAXPAYER NAME AND MAILING ADDRESS <br />us Hess Name Name <br /> Sergio Gutierrez <br />treat Address Street or Other Mailing rcss <br /> PO Box 395 <br />CkY B e Zip C e ity State Zip ode <br /> Grand Isl and NE 68802-0395 ~ <br />Tax <br />Category <br />N <br />b Tax Period Date of Amount of Tax Penalty Interest Addltians Balance of <br />um <br />er <br />4/1/08 thru Assessment Assessment Due <br />01 <br />06/30/200$ 09/17/2008 18.5$ 0.00 2.19 20.77 <br />01 7/1/0$ thru <br />09/30/2008 05/29/2009 250.01 50.00 24.4$ 324.49 , <br />TOTAL ~ $ 345.26 <br />• ••-•--~ ---•••.~ •..~• •.,- ...,..,a~na ..aNo~u~~~,,, ~~ nnvallue Has compllea wltn the revenue laws of the State of Nebraska in the determination of the <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 serv s to continue the priority the state's interest in the affected property of the taxpayer. <br />SI f1 a 'Revenue Senior A ent 08/31/2010 402 471-5727 <br />g ,P'rcparer's (gnat a Tille Date elephone Number <br />here ~ Revenue Senior A ent 08/31/2010 <br />Authorized Signature Title Date <br />A~494-1974 Rev. 2-2002 Superepdes 4 19q-1974 RYV. 101895 <br />'tr <br />1r~ I . <br />i <br />