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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 or hereafter acquired. Department of of the state of and specified a Hen to the taxpayer PLEASE DO NOT WRITE IN THIS SPACE Nebraska Identification Number 26615363 Federal Identification Number Lien Serial Number 11332664 Lien Filed With County Clerk Social Security Number XXX -XX -3391 Spouse's Social Security Number XXX -XX -5842 3 Register of Deeds 1 Date of Lien 05/28/2013 Lien Type County HALL 7 Original 1 Continuation 1 Corrected BUSINESS NAME AND LOCATION ADDRESS TAXPAYER NAME AND MAILING ADDRESS JOHNNY R DALLAND MARNIE R DALLAND 2324 N GRAND ISLAND AVE GRAND ISLAND NE 68803 Tax Category Number Tax Period Date of Assessment _ Amount of Tax Penalty Interest Additions Balance of Assessment Due 22 2008 02/09/2012 174.20 8.71 34.47 217.38 TOTAL $ 217.38 I hereby certify that the Nebraska Department of Revenue has complied with the revenue laws of the State of Nebraska in the determination of the 05/31/2013 FRI 14:32 FAX 402 471 4429 UCC SECRETARY OF STATE o s ignatur Revenue Agent Title 201304288 �yy Hall 0002/002 J E Sec of Stele John R Ga e 9913716193 -6 DRUM JOHNNY Filed: 05/31/2013 12:38 PM Nebraska Department of REVENUE NOTICE OF STATE TAX LIEN www.revenue.ne.gov Di u Pgs 1 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 extension of an effective lien, it servpsJo continue.the ; 'ority of the states interest in the affected property of the taxpayer. sign Prepay � here ■ ��!�J!J Date Telephone Number (402)471 -5789 Revenue Supervisor S, 2? , I3 Title Date 4.494 -1974 Rev. 2-2002 Supersedes 4-494 -1974 Rev. 10 -1995