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Tax <br />__ <br />Category <br />Tax Period <br />Date of <br />Amount of Tax <br />Penalty <br />Interest <br />Addltlons <br />Balance of <br />Number <br />Assessment <br />Assessment Due <br />Dec, 3. 2013 2:40PM NE Secretary of State— UCC <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 a uired. <br />Nebraska Identification Number <br />8091374 <br />Lien Senal Number <br />Date of Lien <br />Business Name <br />Street Address <br />City <br />01/01/2010 <br />12/31/2010 <br />07/01/2011 <br />09/30/2011 <br />10/01/2011 <br />12/31/2011 <br />01/01/2012 <br />09/30/2012 <br />06/29/2012 <br />06/29/2012 <br />1,268.93 <br />41.46 <br />09/29/2013 <br />09/29/2013 <br />725.00 <br />0.00 <br />454.12 <br />2.07 <br />253.75 <br />75.00 <br />175.99 <br />3.51 <br />52.45 <br />0.00 <br />TOTAL <br />21 <br />21 <br />21 <br />21 <br />21 <br />I hereby certify that the Nebraska . - parImenl of Revenue has complied with the revenue laws of the State . Nebraska in the determinallon of the <br />amount shown to be due, and the taxpayer has failed to pay the amount due after demand. If this Notice of Slate Tax Lien is an extension of an <br />effective lien, it ga = , continue the priori e state's interest in the affected properly of the laxp . - r. <br />it Revenue Agent j% JG .4sse, <br />Title <br />Revenue Senior Agent <br />sign <br />here <br />11/18/2013 <br />06/29/2012 <br />12/31/2009 <br />Lien Type <br />BUSINESS NAME AND LOCATION ADDRESS <br />repa rs Spat <br />u o S gnature <br />REVENUE . NOTICE OF STATE TAX LIEN <br />REVENUE .��.yar <br />Lien Fliad Wlth <br />Register of Deeds OCounty Clerk <br />©Original DConnInuatIon ['Corrected <br />State Zip Code <br />0.00 <br />Title <br />2 01309423 <br />Federal Identification Number <br />Name <br />oclat Security Number <br />XXX- XXX7247 <br />County <br />HALL <br />JEFFREY M. REIS <br />Street or Other Mailing Address <br />4145 MANCHESTER <br />City <br />GRAND ISLAND <br />97.12 <br />40.47 <br />No. 2147 P. 2 <br />NE Sr a of i1.{a Jahn R Salo • UCC S7L <br />111 11 <br />69137267114-3 Pm: 1 <br />R 1 11'FREY M, <br />Fled: 12/09/2013 09:42 rm <br />PLEASE DO NOT WRITE IN THIS SPACE <br />TAXPAYER NAME AND MAILING ADDRESS <br />Stale <br />NE <br />Date <br />4 494 - 1974 Rev. 2 - 2002 Supersedes 44944974 Ray, 1049sd <br />pouse's Sociel Security Number <br />Tip Code <br />68803 <br />137.59 <br />1,899.04 <br />47.04 <br />1,031.20 <br />75.00 <br />3 3,189.87 <br />402 471 -6067 <br />Tebphone Number <br />