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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 />City <br />sign <br />here <br />Dec, 17. 2013 1:07PM NE Secretary of State — UCC No. 2407 P. 2/2 <br />This Notice of State Tax Uen 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 />• 10503927 <br />Lien Serial Number <br />/ / �+ic�U, <br />Date of Uen <br />Business Name <br />Street Address <br />01 <br />21 <br />12/08/2013 <br />07101 /2012 11/23/2013 <br />07/31/2012 <br />Authorized Signature <br />Lien Filed With <br />BUSINESS NAME AND LOCATION ADDRESS <br />201309732 <br />Neb.e•k• Dew •1iT er 01 <br />REVENUE NOTICE OF STATE TAX LIEN <br />Register of Deeds EiCount Clerk <br />Lien Type <br />QOriginai OConlinuation DCorrected <br />Zip Code <br />890.00 <br />Tills <br />Federal Identification Number <br />Name <br />Street or Other Mailing Address <br />2715 STEWART DR <br />iy <br />Social Security Number <br />XXX XX -5679 <br />County <br />HALL <br />TAC -XUAN DIP <br />GRAND ISLAND <br />PLEASE DO NOT WRITE IN THIS SPACE <br />TAXPAYER NAME AND MAILING ADDRESS <br />04/01/2012 <br />09/30/2012 <br />11/23/2013 <br />245.75 <br />57.71 <br />11.00 <br />TOTAL, <br />178.00 <br />1 hereby certify that the Nebraska Department of Revenue has complied with the revenue laws of the Slate 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 Stale Tax Lien i9 an extension of an <br />effective lien, it se continue the priority slate'a interest In the affected property of the taxpayer. <br />41.23 <br />'Revenue Agent <br />Tide <br />Revenue Senior Agent <br />NE or of Stake John A Oslo UCC STL <br />IBM <br />9913727441 -6 P9e: 1 <br />TRC -XUf 4 DIP <br />Filed: 12/17/2013 11142 AM <br />Spouse's Social Security Number <br />Slate <br />NE <br />Zip Code <br />68801 <br />1,109.23 <br />314.46 <br />$ 1,423.69 <br />402 471 -6067 <br />Telephone Number <br />Dale <br />4 -494 -1974 Rer. 22009 Supersede' 4191 -1974 Rev. 10-1995 <br />