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Tax <br />Category <br />Tax Period <br />Date of <br />Amount of Tax <br />Penalty <br />Interest <br />Additions <br />Balance of <br />Number <br />— w - __ ^w <br />Assessment <br />Assessment Due <br />07/05/2013 FRI 13:25 FAX 402 471 4429 UCC SECRETARY OF STATE <br />This Notice of State Tax Lien is issued by the Nebraska Department of <br />Revenue for unpaid taxes pursuant to the revenue laws of the state of <br />Nebraska. Notice is hereby given that taxes including penalties and <br />interest, which are shown below, are due from the taxpayer specified <br />below and remain unpaid after demand. These taxes constitute a lien <br />in the county for real and personal property belonging to the taxpayer <br />or hereafter acquired. <br />Nebraska Identification Number <br />8239665 <br />Lien Serial Number <br />113.57 7yy <br />Date of Lien <br />Business Name <br />Street Address <br />City <br />01 <br />01 <br />21 <br />06/16/2013 <br />02/28/2013 06/16/2013 <br />Lien Filed With <br />Lien Type <br />BUSINESS NAME AND LOCATION ADDRESS <br />State Zip Code <br />201305437 <br />t'is4braska E rpsrttniwit of <br />w RE , ' EE NOTICE OF STATE TAX LIEN <br />Register of Deeds (County Clerk <br />Original OContinuation Corrected <br />49,644.98 <br />Federal Identification Number <br />Name <br />Revenue Agent <br />12,633.21 <br />PLEASE DO NOT WRITE IN THIS SPACE <br />Social Security Number <br />XXX -XX -6064 <br />Hall 0002 /003 <br />County <br />HALL <br />RICHARD WISEMAN <br />Street or Other Mailing Address <br />103 BEACHWOOD DR <br />City <br />GRAND ISLAND <br />6,922.80 <br />NE Sec of State John 11 Gale - UCC <br />9913718150 -8 Pgs: <br />WISEMAN RICHARD <br />Filed: 07/05/2013 12:44 PM <br />T <br />Spouse's Social Security Number <br />TAXPAYER NAME AND MAILING ADDRESS <br />State <br />NE <br />sign ' Prepar Sig( S'c.o'� Title <br />here Revenue Senior Agent <br />uthorized Signature Title Date <br />4 - 494 1974' Rev. 2 - 2002 Supersedes 4 - 494 - 1974 Rev. 104995 <br />Zip Code <br />68803 <br />09/01/2006 <br />07/31/2009 <br />01/01/2012 <br />09/30/2012 <br />06/16/2013 <br />06/16/2013 <br />78,885.00 <br />1,485.03 <br />7,888.50 <br />282.67 <br />22,422.52 <br />61.73 <br />TOTAL <br />69,200.99 <br />109,196.02 <br />1,829.43 <br />$ 180,226.44 <br />I hereby certify that the Nebraska Department o Revenue has complied with the revenue laws of the State of Nebraska in the determination of the <br />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 <br />effective lien, it se o continue the priori f the state's interest in the affected property of the taxpayer <br />402 471 -6067 <br />Telephone Number <br />