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This Notice of State Tax Lien is issued by the Nebraska Revenue for unpaid taxes pursuant to the revenue laws Nebraska. Notice is hereby given that taxes including penalties interest, which are shown below, are due from the taxpayer below and remain unpaid after demand. These taxes constitute in the county for real and personal property belonging to or hereafter acquired. Department of of the state of and specified a lien the taxpayer PLEASE DO NOT WRITE IN THIS SPACE Nebraska Identification Number 97411345 Federal Identification Number Lien Serial Number 11318015 Lien Filed With 3 Register of Deeds I County Clerk Social Security Number XXX - XX - 0393 Spouse's Social Security Number Date of Lien 02/12/2013 Lien Type a Original • Continuation II Corrected County HALL BUSINESS NAME AND LOCATION ADDRESS TAXPAYER NAME AND MAILING ADDRESS FRANCIS A ANDRUGA 912 W 1ST STREET GRAND ISLAND NE 68801 Tax Category Number . Tax Period Date of Assessment Amount of Tax Penalty Interest Additions Balance of Assessment Due 22 2008 10/16/2011 212.59 10.63 40.24 263.46 22 2009 12/16/2011 132.00 6.60 18.39 156.99 TOTAL $ 420.45 I hereby certify that the Nebraska Department of Revenue has ommnlied with the revenue laws of the State of Nebraska in the determination of the 02/14/2013 THU 14:57 FAX 402 471 4429 UCC SECRETARY OF STATE oti 201301260 Hall 2003 /003 N E See of State John A Gale - UCC STL 9913708786 -3 PHs ANDRUGA FRANC 5 A Fi ed: 02/ 4/2013 11:45 AM Nebraska Department of REVENUE NOTICE OF STATE TAX LIEN www.revenue.ne.gov amount shown to be due, and the taxpayer has ailed to pay the amount due after demand. If this Notice of State Tax Lien is an extension of an effective lien, it selves to Conti, - priority of the states interest in the affected property of the taxpayer. (402)471 -6043 Telephone Number • % . 1? Title Date 4. 494.1974 Rev. 2-2002 Supersedes 4. 494.1974 Rev. 10-1995 Revenue Agent die Revenue Supervisor /.2 - Date X13