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This Notice of State Tax Lien is issued by the Nebraska <br />Revenue for unpaid taxes pursuant to the revenue laws <br />Nebraska. Notice is hereby given that taxes including penalties <br />interest, which are shown below, are due from the taxpayer <br />below and remain unpaid after demand. These taxes constitute <br />In the county for real and personal property belonging to <br />or hereafter acquired. <br />Department of <br />of the state of <br />and <br />specified <br />a lien <br />the taxpayer <br />PLEASE DO NOT WRITE IN THIS SPACE <br />Nebraska Identification Number <br />28041291 <br />Federal Identification Number <br />Lien Serial Number <br />11317789 <br />T Lien Filed With <br />County Clerk <br />Social Security Number <br />XXX -XX -0413 <br />Spouse's Social Security Number <br />XXX -XX -2294 <br />3 Register of Deeds II <br />Date of Lien <br />02/11/2013 <br />Lien Type <br />County <br />HALL <br />7 Original II Continuation • Corrected <br />BUSINESS NAME AND LOCATION ADDRESS <br />TAXPAYER NAME AND MAILING ADDRESS <br />GARY H CARSON <br />MARILYN M CARSON <br />4540 W 13TH ST <br />GRAND ISLAND NE 68803 <br />Tax <br />Category <br />Number <br />Tax Period <br />Date of <br />Assessment <br />Amount of Tax <br />Penalty <br />Interest <br />Additions <br />Balance of <br />Assessment Due <br />22 <br />2007 <br />10/31/2012 <br />5,694.57 <br />1,423.64 <br />1,483.87 <br />8,602.08 <br />22 <br />2008 <br />10/31/2012 <br />4,701.59 <br />1,175.40 <br />889.57 <br />6,766.56 <br />22 <br />2009 <br />10/31/2012 <br />3,782.40 <br />945.60 <br />526.53 <br />5,254.53 <br />22 <br />2010 <br />10/31/2012 <br />4,214.02 <br />1,053.51 <br />375.91 <br />5,643.44 <br />TOTAL <br />$ 26,266.61 <br />I hereby certi <br />that the Nebraska Deoartment of Revenue has comoiied with the revenue laws of the State of Nebraska in the determination of the <br />02/13/2013 WED 15:11 FAX 402 471 4429 UCC SECRETARY OF STATE <br />effective lien, it se p : , to continue <br />f l . / t- Aj / _�� <br />sign igna <br />here ■ <br />rized,Signature <br />Nebraska Department of <br />Preparers <br />201301239 <br />REVENUE NOTICE OF STATE TAX LIEN <br />ww w.revenue.ne.gov <br />amount shown to be due, and the taxpa er has failed to pay the amount due after demand. if this Notice of State Tax Lien is an extension of an <br />only of the state's interest in the affected property of the tax • = yer. <br />/ / /3 <br />tle <br />Revenue Agent <br />evenue Su • ervisor <br />Title <br />�yy <br />Hall 0002/003 <br />, al�lllp� ' 1�d � <br />(402)471 -5789 <br />Telephone Number <br />Z, /// /3 <br />Date <br />4.494.1974 Rev. 2-2002 Supersedes 4. 494.1974 Rev. 10.1995 <br />