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05/11/2011 WSD 14:47 FAX 402 471 4429 UCC SSCRETARY OF 5TATS -��y 8a1.1 <br />�, <br />/ <br />2nt�(►�53L <br />�,Te�Duf� rfs+rs <br />��i„�E <br />�ooa/ooa <br />a lahn p Os1e . U[C SR <br />-6 Pes: 1 <br />G. <br />/20i1 02:33 PM <br />NOTICE OF STATE TAX LIEN <br />This Notice of State Tax Lien Is issued by the Nebraska Department of <br />Revenue for unpald 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 tt�e tanpayer specifled <br />below and remain unpaid after demand. These taxes constitute a Ilen <br />fn the county for reaf and personal property belonging to the taxpayer <br />or hereafter acquired. _ <br />�, �:.. <br />Category <br />Number <br />21 <br />21 <br />21 <br />// lSJ�.3'� nX, R�istar of Deeds �County <br />'en lie� TyPe <br />05/05/2Q11 [X]Original []Continuation <br />BUSINESS NAME AND LOCATfOP1 ADDRESS <br />Tax Periad I Date of <br />".."'.`""" 03/21/2009 <br />09i30/2008 <br />10/01 /2008 11 /30/2009 <br />12/31/2008 <br />01/01/2Q09 11/30/2009 <br />06/30/2009 <br />Amount cf Tax <br />� �� <br />i� �� <br />��� �� <br />l <br />XXX-XX-4495 <br />(]corre�ted Ha{I <br />TAXPAYER NAME AND MAILING ADDR�SS <br />� <br />Erika G. Flores <br />t ar Other Malling Address <br />327 Roush Lane � <br />State Zip Code <br />Grand Island Ne. 68801 <br />Pertalty I�tarest Additions Balanee of <br />75.00 <br />125.00 <br />200.00 <br />� �� <br />56.44 <br />94.39 <br />TOTAL <br />75.00 <br />681.44 <br />1,294.39 <br />$ 2,050.83 <br />I hereby certify that the Nebraska Depertment of Revenue nas comptietl wttn the revenue iaws or me s�ate or rearasna �n u�n �Cw�������puy�� �� u�o <br />amount shown to be due, the taxpeyer h failed to pay the amount due after demand. If this Notice oi State Tax Lien is an extension of an <br />effecWe lien, it serv tinue the pri of the state's interest in the atfected property of the taxpayer. <br />e �, Revenue Agent S o9 v�/ 402 471�067 <br />S19r1 Prepa �s Sign ture Tltle Da e Telephone Number <br />here 8 Senior Revenue Agent f � <br />thorized Signature Title Date <br />- 4-aea.tista Rs�. 2-2uoz s�,aer�a� a�asa-��a Rev. �a�sss <br />i <br />i <br />