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Nebraska Identification Number 29142474 Federal Identification Number Lien Serial Number 11315566 lien Filed With County Clerk Social Security Number XXX - XX - 7233 Spouse's Social Security Number 3 Register of Deeds II Date of Lien 01/28/2013 Lien Type County HALL 'a Original • Continuation 11 Corrected BUSINESS NAME AND LOCATION ADDRESS TAXPAYER NAME AND MAILING ADDRESS RANDOLPH D LONOWSKI 204 BROOKLINE DR GRAND ISLAND NE 68801 Tax Category Number Tax Period Date of Assessment Amount of Tax Penalty Interest Additions Balance of Assessment Due 22 2011 05/09/2012 3,347.00 168.35 126.99 3,642.34 TOTAL. $ 3,642.34 02/01/2013 FRI 12:31 FAX 402 471 4429 UCC SECRETARY OF STATE 201300859 This Notice of State Tax Lien is issued by the Nebraska Department of Revenue for unpaid taxes pursuant to the revenue laws of the state of Nebraska. Notice is hereby given that taxes including penalties and interest, which are shown below, are due from the taxpayer specified below and remain unpaid after demand. These taxes constitute a lien in the county for real and personal property belonging to the taxpayer or hereafter acquired. sign P� here ■ Nebraska Department of REVENUE NOTICE OF STATE TAX LIEN www.revenue.n -gov evenue Agent Title Revenue Supervisor Title 9913707721 -6 Pas: 1 LONOWSKI RANDOLPH 0 Filed: 01/31/2013 09:48 PM PLEASE lm NOT WRITE IN THIS SPACE PLEASE RETURN TO: NEBRASKA DEPT OF REVENUE PO BOX 94609 LINCOLN NE 68509 -4609 I here certify that the Netxaska Department of Revenue has complied with the revenue laws of the State of Nebraska in the determination of the amount shown to be due, and the r - has failed to pay the amount due after demand. If this Notice of State Tax Lien is an extension of an effective lien, it serves to continue - tayerest in the affected property of the taxpayer. (308)632 -1206 4494 -1974 Rev. 2 -2002 Supersedes 4- 494 -1974 Rev. 10-1995 2003/003 r.