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Tax <br />Category <br />Tax Period <br />Date of <br />Amount of Tax <br />Penally <br />Interest <br />Additions <br />Balance of <br />Number <br />Assessment <br />Aveeeyment Due <br />Jan. 29. 2014 3:29PM 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 ac • uired. <br />Nebras a . one = on <br />8923027 <br />Lien Serial Number <br />/ L — i <br />Dale Lien <br />01 /2312014 <br />Business Name <br />Street Address <br />Oily <br />01 <br />01 <br />01 <br />• 01 <br />sign <br />here <br />UM <br />Huseins NAME AND LOCATION ADDRESS <br />01 10/0112010 02/07/2011 <br />12/31/2010 <br />01 <br />Authorized Signature <br />201400544 <br />p_brN.ta 1.4u.4 1 - Orr! a' <br />REVENUE NOTICE OF STATE TAX LIEN <br />Lien Filed With <br />Register of Deeds l !County Clerk <br />Federal Identification Number <br />Lien Type <br />Original DContinustion Corrected <br />:State Zip Code <br />. 115.18 <br />Name <br />25.00 <br />Revenue Agent <br />Title <br />Revenue Senior Agent <br />Title <br />Social Security Humber <br />XXX -XX -8675 <br />County <br />Hall <br />Kathleen D. Davidson <br />Street or Other Mailing Address <br />226 W, Stoney Park Rd <br />City <br />Grand Island <br />20.57 <br />No. 3091 P. 3/3 <br />NE s._ as a4.4e J.M+ s y1G - ucc s7L <br />11 1111 <br />1111 <br />III <br />1ILI <br />99t4725744 -2 Pus: 1 <br />DAVIDSON KATHLERINI C. <br />Fils+t+ D1(19! i D1:27 PM <br />PLEASE DO NOT WRITE IN THIS SPACE <br />Spouse's Social Security Number <br />TAXPAYER NAME AND MAILING ADDRESS <br />State <br />Ne. <br />07/01/2011 <br />11/02/2011 <br />09/30/2011 <br />10/01/2011 02/02/2012 <br />12/31/2011 <br />01!01!2012 05/01/2012 <br />03/3112012 <br />04/01/2012 <br />06/30/2012 <br />09/04/2012 <br />07/01 /2012 12/03/2012 <br />09/30/2012 <br />69.14 <br />0.00 <br />0. <br />0.00 <br />46.08 <br />25.00 <br />0.00 <br />25.00 <br />25.00 <br />25.00 <br />6.31 <br />0.06 <br />0.02 <br />0.07 <br />1.92 <br />TOTAL <br />0.06 <br />25.02 <br />25.07 <br />73.00 • <br />$ 384.35 <br />t hereby certify that the Nebraska ' pertinent of Revenue has complied with the revenue lows o I e late • 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 Slate Tax Lien is en extension of an <br />affective ten, It . - jr: . hllnue the prifi the state's interest In the affected property of the laxpa <br />402 471 -6087 <br />Telephone Number <br />Data <br />4494 -1474 Rev. 2-2002 Sups sWe.4454.1574 Rev. 10.1455 <br />Zip Code <br />68801 <br />160.75 <br />100.45 <br />