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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 />Dec. 11. 2013 2:10PM NE Secretary of State - UCC <br />a <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 />9392300 <br />Lien Sena! Number <br />/ <br />Dale of Lien <br />11/30/2013 <br />Business Name <br />Street Address <br />City <br />01 07/01/2010 02/07/2011 <br />07/31 /2010 <br />01 <br />01 <br />01 <br />BUSINESS NAME AND LOCATION ADDRESS <br />• <br />sign <br />here asiit <br />uthorized Signs re <br />repere?s Slgna re <br />201309607 <br />Lien Filed With <br />Register of Deeds []County Clerk <br />Lien Type <br />\wbrysk■ 1eaJrIrmehl o <br />REVENUE NOTICE OF STATE TAX LIEN ( ,;1' ° ' <br />State Zip Code <br />0.00 <br />Title <br />Federal Identification Number <br />Social Security Number <br />XXX -XX -9692 <br />Name <br />r <br />Original DContinualion © Corrected HALL <br />No, 2302 P. 2/2 <br />ME Sou of 3 John A sole - Ucc .TL <br />9913727090 - 1 peg: 1 <br />Filed 12/11/2 1 /1 013 10:14 Afl <br />PLEASE DO NOT WRITE IN THIS SPACE <br />Spouse's Social Security Number <br />XXX -XX -6084 <br />TAXPAYER NAME AND MAILING ADDRESS <br />RYAN D. & KELLIE R. ONEILL <br />Street or Other Mailing Address <br />429 WYANDOTTE ST. <br />City <br />GRAND ISLAND <br />1.10 <br />State <br />NE <br />• <br />Zip Code <br />68801 <br />04/01 /2011 <br />12/31/2011 <br />04/01/2012 <br />06/30/2012 <br />07/01/2012 <br />03/31 /2013 <br />04/02/2012 <br />11/01/2012 <br />06/03/2013 <br />56.68 <br />1.80 <br />140,44 <br />25.00 <br />50.Q0 <br />0.00 <br />75.00 <br />12.25 <br />0,31 <br />3.14 <br />TOTAL <br />26.10 <br />118.93 <br />2.11 <br />218.58 <br />365.72 <br />I hereby certify that the Nebraska Department of Revenue hes 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 - Iled to pay the amount due after demand. If this Notice of State Tax Lien is en extension of an <br />effective hen. it se r'conttnue the prio e state's interest in the affected property of the taxpayer. <br />402 471 -6067 <br />Revenue Agent i O a , <br />Title Dal Telephone Number <br />Revenue Senior pent 12-16— L3 <br />Dole <br />+404 -1974 Rev. 2-2002 Supersedes 4- 194 -1974 Rev. 10 -1996 <br />