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12/09/2011 FR= 14:43 FAx 402 471 4429 UCC SECRETARY OF STATE -�-�-� Hall <br />�� <br />20110928� <br />�003/003 <br />PLEASE RETURN T0: <br />NEBRASKA DEPT OF REVENUE <br />1313 FARNAM-0N THE-MALL <br />OMAHA NE 68102-1871 <br />� N�sbr Depart�nent af <br />��N�� NOTICE OF STATE TAX LIEN <br />www.reve n'u e. n a.gov <br />This Notice of State Tax Lien is issued by the Nebraska Departrne�t of <br />Revenue for unpaid �xes pursuant to the revenue laws of the state of <br />Nebraska. Notice is hereby glven that taxes including penafties and <br />interest, which are shown below� are due from the taxpayer spec(fied <br />below and �emain unpaid aRer demand. These taxes constitute e lien <br />in the county for real and personal propeKy betonging to the taxpayer <br />97160067 <br />Uen 5erial Number Lien Filed Wilh Soc�al Secwity Number Spouse's Sactal S <br />11166556 �Register of Deeds �County Clerk XXX XX � <br />Date of Lien Lien Type C���Y <br />12/07/2011 �original �Continuation �Corrected HALL <br />9USINESS NAME AND LOGATION ADDRESS '�AXPAYER NAME AND MAIUNG ADDRESS <br />ISRAEL PEREZ <br />709 W LOUtSE <br />GRAND ISLAND NE 68801 <br />Category Tax Pedod Date of <br />Number Assessmer�t <br />22 2009 06/29/2011 <br />amount shovm to be due, and the tax� <br />effecGvelien, it serves to conqnue tha <br />Si911 . , Preparer t <br />here ► � <br />� <br />. . Authorized Sign e <br />Amount of Taz Penalty <br />323.00 16.15 <br />Interest I .Addttions <br />26.54 <br />Balance ot <br />365.69 <br />e <br />I � I T07AL � I$ � � 365.69 I f- <br />� <br />:nt of Revenue has compiied with the revenue laws of the State o1 Nebraska in the determ nauon af the • �• <br />bas fa7ed lo pay the amount due after demand. If this NoUce of State Tax Lien is an extension ot an ; <br />ityiof ihe state's interest in ihe effeeted prapedy of the taxpayer. . , . 4 <br />` !. <br />� Revenue Agent ' f,x '�` � f (3U8�3212U3 <br />TiUe Date - Te{ephone N m6er <br />i <br />Revenue Supervisor � , �- <br />TiGe. . . . Dat _ .. . <br />' 4�&1-187A Rav. 2-zoD2 5uper�edes 1-4e4-1971 Rav �o L <br />, . . . . . `.�� i <br />. . • - r... <br />. . .. . � . - , • i• <br />. . . '' <br />