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Pra7gtam <br />Tas Period <br />a st�msntant <br />our <br />Penally <br />sorest <br />Costs <br />TbNaI Due <br />Individual <br />2007 <br />05/18/1013 <br />630.00 <br />209.50 <br />242.75 <br />1,290 23 <br />Individual <br />2011 <br />10117/2012 <br />932.00 <br />46.60 <br />63.53 <br />1,042.13 <br />Total <br />$2,332.38 <br />Feb. 4, 2014 2:58PM NE Secretary of State — UCC <br />Nk�r :Vs o.pstmrinr or <br />REVENUE <br />This Notice of State Tax Lien is issued by the Nebraska <br />Department or Revenue for unpaid taxes administered by Molex <br />Commissioner, Taxes, including penalties, Interest, and costs, <br />which are s beiow, are due from the taxpayer and remain <br />unpaid after demand.These taxes area lien for all property located <br />in the cowity and rights to property owned by the taxpayer or <br />acquired before the expiration of this Iien.This lien will expire and <br />become unenforceable 10 years atter the date of recording if no <br />continuation statement is recorded on or prior to the expiration of <br />the previous limn or continuation statement. <br />Nebraska ID Number <br />99000741 <br />Liar Serial Number <br />11429045 <br />Date of Lin <br />01131/2014 <br />1 <br />sign <br />here <br />Business Name and Location Address <br />I caw* that y Noblemen <br />the <br />zed Strome <br />uen ReCI : <br />® Roemer al Diode <br />lien Type! <br />0 <br />201400655 <br />Notice of State Tax Lien <br />❑ County dark <br />PLEASE D4 NOTWRITE IN THIS SPACE <br />Federal ID Number <br />SKIM Security Number <br />XXX - XX - 3588 <br />El Continuation El Corroded <br />CAMERON L WERTZ <br />404 W 15TH ST <br />GRAND ISLAND NE 60001 <br />Tits <br />Revenue ervisor <br />Tile <br />NE Sao of Skala Jaw, a 1.1. - VC( STL <br />9914729969 -8 Pen: 1 <br />IFUgd: e2 12:15 PM <br />Spouse's Social saainry Number <br />County <br />HALL <br />Taxpayer Name and *Nine Address <br />No. 3181 P. 2 <br />us has oranpted with the ern of Ira sate of Nebraska In determining in the mewl shown lobe sm <br />due after dement 7lys. N14Ice of Slate Taos Uen b en Weeks Nan and warns to minus Its peach/ of <br />Phone Number <br />Dee <br />4464 -1971 Rev. 2-21)1a Sgyrls0es 499 1974 9& 2 <br />