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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 />Assessment <br />Assessment Due <br />Oct. 25, 2013 2:50PM NE Secretary of State — UCC <br />OIS <br />Lien Serial Number <br />Date of Lien <br />Business Name <br />treet Address <br />City <br />21 12/31/2009 09/24/2013 <br />21 <br />21 <br />0 <br />sign <br />here ID <br />10/16/2013 <br />BUSINESS NAME AND LOCATION ADDRESS <br />State <br />oAr..4r :troy AT ent e& <br />201308573 <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 />9715991 <br />REVENUE NOTICE OF STATE TAX LIEN <br />Federal Identification Number <br />Lien Filed With ISociai Security Number <br />Register of Deeds DCounty Clerk XXX -XX -5271 <br />Lien Type . <br />®Ori Continuation 0Corrected <br />887.92 <br />Title <br />Name <br />DONNA WRATTEN <br />Street or Other Mailing Address <br />605 E BISMARK <br />• ky <br />GRAND ISLAND <br />1/1/2010- <br />12/31/2010 <br />111/2011- <br />12/31/2011 <br />h <br />09/24/2013 <br />09/24/2013 <br />D <br />1,397.61 <br />2,978.80 <br />tReve <br />i i ed,�l i th <br />542.16 <br />744.70 <br />I <br />210.21 <br />207.46 <br />TOTAL <br />408.28 <br />202015795 <br />Revenue Senior Agent 0 <br />Title <br />Revenue Senior Agent <br />County <br />HALL <br />No. 1598 P. 2 <br />N1 See of S4.4. John A Gala - UtC sTL <br />ill l <br />9913724949 -7 Pas: 1 <br />WRATTEN DONNA <br />Filed: 10/25/2013 09:42 AM <br />W <br />PLEASE DO NOT RITE IN THIS SPACE <br />Spouse's Social Security Number <br />TAXPAYER NAME AND MAILING ADDRESS <br />207.16 <br />1 hereby nearly that t e Nebraska apartment o Revenue has comp a revenue aws of the State o Nebraska in the determination of the <br />amount shown to be due, and the taxpayer has faded to pay the amount due after demand.. If this Notice of State Tax Lien is an extension of an <br />effective lien, 11 serves to continue the priority of the state's interest in the affected property of the taxpaye <br />/2,9 <br />1 <br />State <br />NE <br />Zip Code <br />68801 <br />1,503.36 <br />2,150.00 <br />3,930.96 <br />$ 7,684.32 <br />402 471 -5709 <br />ate Telepho a Nun er <br />10/2-#20 ? <br />Date <br />4494 -1974 Hw. 2 -2002 Sowoedea 4-404.1974 Rw. 10 -1905 <br />