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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 <br />or hereafter acquired. . <br />Department of <br />of the state of <br />and <br />specified <br />a lien <br />to the taxpayer <br />PLEASE DO NOT WRITE IN THIS SPACE <br />PLEASE RETURN TO: <br />NEBRASKA DEPT OF REVENUE <br />- p0 BOX 94609 <br />LINCOLN NE 685094609 <br />I <br />Nebraska Identification Number <br />47157798 <br />Federal Identification Number <br />Uen Serial Number <br />11340045 <br />Lien Filed With <br />O Register of Deeds 1 County Clerk <br />Social Security Number <br />XXX -XX- 8643 <br />Spouse's Social Security Number <br />Date of Uen <br />06/11/2013 <br />Lien Type <br />IZi Original ['Continuation ['Corrected <br />County <br />HALL <br />BUSINESS NAME AND LOCATION ADDRESS <br />TAXPAYER NAME AND MAILING ADDRESS <br />ESTELLA F ADRIAN <br />1115 W ANNA STREET <br />GRAND ISLAND NE 68801 <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 />2006 <br />11/30/2012 <br />2,816.00 <br />704.00 <br />987.45 <br />4,507.45 <br />22 <br />2007 <br />01/11/2013 <br />15,833.24 <br />3,958.31 <br />4,281.92 <br />24,073.47 <br />22 <br />2009 <br />01/11/2013 <br />9,504.24 <br />2,376.06 <br />1,416.78 <br />13,297.08 <br />TOTAL <br />$ 41,878.00 <br />I hereby certify that the Nebraska Department o <br />amount shown to be due. and the taxaaveF.hass failed-ft) <br />Revenue has complied the revenue laws of the State of Nebraska in the determination of the <br />eau fhe arnru mt di me afar rlomand If thie Nntinp of Ctafa Tar I ion le an avtanann of on <br />06/14/2013 FRI 14:39 FAX 402 471 4429 UCC SECRETARY OF STATE <br />201304738 <br />yy� <br />Nebraska Department Department of <br />REVENUE NOTICE OF STATE TAX LIEN <br />www.revenue.ne.gov <br />sign <br />here - <br />serves continue -lam • ty . - <br />effective lien, it to b th <br />e <br />Title <br />t in the affected property of the taxpayer. <br />enue Agent <br />Revenue Supervisor <br />Hall 0002/002 <br />v soon q Gale - UCC STL <br />111111111111111111111 <br />Filed: 06/14/2013 11:34 AM <br />(308)632 +1206 <br />Da <br />4. 494.1974 Rev. 2.2002 Supersedes 4. 464.1974 ev. 10-1995 <br />