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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 />ec. 2013 1:13PM NE Secretary of State — UCC <br />2 01309967 <br />1h;yvrlkm r'r ■ elff rim( 40{ <br />This Notice of State lax 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 />10906215 <br />Lien Series Number <br />//3.G. 705" <br />Dale Lien <br />Business Name <br />Street Address <br />City <br />01 <br />sign <br />here <br />12/18/2013 <br />BUSING NAME AND LOCATION ADDRESS <br />01 09/30/2012 11/11/2013 <br />10/01/2012 <br />12/31/2012 <br />11/11/2013 <br />110.00 <br />36.00 <br />3,00 <br />Prep grer sSignature <br />uthorized Signature <br />REVENUE NOTICE OF STATE TAX LIEN <br />V•7YM1. T 1.••YV•l Wa. • T. eI OY <br />Lien Filed Wkh <br />©Register of Deeds ['County Clerk <br />Lien Type <br />Original IContinuation <br />State Zip Code <br />110.00 <br />Title <br />'Federal identification Number <br />Name <br />Street or Other Mailing Address <br />PO BOX 5862 <br />City <br />Revenue Agent <br />Title <br />FACUNDO'TOLEDO <br />GRAND ISLAND <br />36.00 <br />Socal Security Number <br />XXX -XX -8480 <br />County <br />HALL <br />Corrected <br />Revenue Senior Agent <br />27- 5139778 <br />PLEASE DO NOT WRITE IN THIS SPACE <br />1 <br />426 <br />No. 2582 P. 3 <br />NE Set .f 5+Me John Sere - ELY STL <br />lit ' d <br />1 i <br />i <br />9913727963 -2 Pas= 1 <br />TOLEDO FACUN1O <br />Filed, 2/26/2013 09E07 RR <br />Spouse's Social Security Number <br />TAXPAYER NAME AND MAILING ADDRESS <br />State <br />NE <br />Dale <br />4494 -1974 Rev. 2-2092 supermen 4494 -19741 Rev. 10 -1995 <br />Zip Code <br />68802 <br />15026 <br />149.00 <br />TOTAL. $ 299.26 <br />1 hereby certify that the Nebraska ()apartment of Revenue has complied with the revenue aws of the Stat or Neb raska in the determination of the <br />amount shown to be du nd the taxpayer has ' 10 pay the amount due after demand. If This Notice of Slate Tax Lien is an extension of an <br />effective lien, it se continue the priori slate's interest in the affected property of the taxpayer <br />402 471-6067 <br />7e ephone Number • <br />�' I <br />