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10/28/2011 FRi 15:10 FAX 402 471 4429 UCC SECRETARY OF STAT$ ��-� 8a11 <br />�i <br />, <br />�J003/003 <br />NE See oi Stn�e John R Gale - UCt STL <br />9911675451-0 Pss: 1 <br />BERMUDEZ CRRLOS <br />Filed: 10/28/2011 08:38 pM <br />dwliaBr•isk� De�vaart�rxl�lrt tluF <br />�E'�"F��E NOTICE OF STATE TAX LIEN <br />,�.,�.,�.�.,,r��....�.�,�, <br />� <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 speciffed <br />below and remain unpaid after demand. These taxes constitute a Ifen <br />in the county for real and personal property belonging to the taxpayer <br />ar hereafter acauired. � <br />`�U1108140 <br />9788409 <br />� I � �Registerof Dceds �County <br />ien ype <br />07/29/2011 �X Original [�Continuatlon �Corrected Hall <br />BUSINESS NAME AND LOCATION ADDRESS TAXPAYER NAME AND MAILING ADDRESS <br />! <br />CARLOS BERMUDEZ <br />t or ther Ma I ng Ad ress <br />2543 THERESA ST, TRLR B3 <br />State <br />Category <br />Number <br />Q1 <br />01 <br />01 <br />Tax Period I Date of <br />" """" - 05118/2011 <br />12/31/2007 <br />1 /1/2008- 05/18/2011 <br />12/31/2009 <br />�ocx-�oc-4796 <br />I.INCOLN NE 68521 <br />Amount oP Tax Penalty IMarest Additions Balance of <br />Assessment Due <br />987.99 � 197.60 201.06 1,386.65 <br />0.00 50.00 0.00 50.00 <br />I I . I" I . I T.OTAL .. 1$ 1,436.65 <br />i <br />i�hereby certi that t e e��asTpartment o Revenue as complied with e revenue laws of the State of Nebraska in the etermination o� 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 eMension of an <br />effective Gen, it se es to continue the priority of the state's interest in the affected properry of the taxpayer. � <br />e � Revenue Senior Agent � 402 471-5709 <br />sign rep na ure • `�'i e . '• ate , eep one Number <br />here e Revenue Senior Agent � �' � �0�."�-? l z(J/� <br />ulhor' S' a re Title � Date <br />4-494-1974 Rav. 2-20D2 &upetsede8 4-0941874 Rev. 1D-1885 � . <br />�� <br />� <br />� <br />