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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 ac 1 uired. <br />Department of • <br />of the state of , <br />and <br />specified <br />a Ilen <br />the taxpayer <br />1 <br />• gst3n4527 <br />FLEMIN6 <br />Filed: 1 <br />0 <br />11 <br />1 11' <br />1 h 01 <br />- 5 <br />hWRT1N L <br />0!2112013 02:06 <br />Pn :: 1 <br />PA <br />Nebraska Identification Number <br />46647848 <br />Federal Number <br />Lien Serial Number <br />11322365 <br />Lien <br />IXIRegister <br />Filed wth <br />County Clerk <br />Social Security Number <br />XXX -XX -4843 <br />Spouse's Social Security Nunber <br />of Deeds II <br />Date . <br />10/16/2013 <br />Lien Type <br />ElCorreded <br />. my <br />HALL <br />71 Original ■ Continuation <br />BUSINESS NAME AND LOCATION ADDRESS <br />TAXPAYER NAME AND MAULING ADDRESS <br />MARTIN L FLEMING <br />3819 CURRAN CT 4 <br />GRAND ISLAND NE . 68803 <br />Tax <br />Category <br />Number <br />Tax Perbd <br />Date of <br />Assessment <br />Amount of Tax <br />Penalty <br />Interest <br />Additions <br />Balance of <br />Assessment Due <br />22 <br />2010 <br />03/19/2013 <br />236,00 <br />11.80 <br />25.85 <br />273,85 <br />22 <br />2012 <br />04/25/2013 <br />187.80 <br />28.34 <br />6,04 <br />220.18 <br />TOTAL <br />$ 493.83 <br />1 hereby cerVy that the Nebraska Department of Revenue has complied with tie revenue laws of the State of Nebraska in the determinalion of the <br />amount shown to be due. and the tamer aver has failed In ow the amount due after demand. If This Notice of State Tex Lien is an ehdension of an <br />Oct. 21. 2013 3:0OPM NE Secretary of State — UCC No, 1517 P. 2 <br />effective lien, it serves to <br />sign <br />here ► <br />Nebraska Department of <br />www.revenue,ne.gov <br />201308468 <br />it Al <br />'W 7M <br />Tide <br />Revenue Supervisor <br />Revenue Agent <br />PLEASE RETURN TO: <br />NEBRASKA DEPT OF REVENUE <br />PO BOX 94609 • <br />LINCOLN NE 68509 -4609 <br />REVENUE NOTICE OF STATE TAX LIEN <br />'8 Interest M the affected property of the temayer. <br />Dare <br />- UCC sn <br />(306)632.1203 <br />Date <br />4-491 -1974 Rev. 2-2002 5urereelee 4-494 -1974 Rev. 191995 <br />