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Tex Category Tax Period Date of Amount of Tex Penalty Interest Additions Balance of •Nurnber Assessment Assessment Due Feb. 27. 2014 3:I3PM NE Secretary of State — UCC r This Notice of State Tax Lion is issued by the Nebraska Department of Revenue for unpaid taxes pursuant to the revenue laws of the state of Nebraska. Notice is hereby given that taxes including penalties and interest, which are shown below, are due from the taxpayer specsfled below and remain unpaid after demand. These taxes constitute a lien in the county for real and personal property belonging to the taxpayer or hereafter ac . uired, Nebraska Identlfkat1on Number Federal Idenlifica 11290897 Lien Serial Number 711S' Dale of Lien Business Name 5 ess 01 10/01/2012 12/31/2012 01 01/01/2013 03/31 /2013 01 02/22/2014 BUSINESS NAME AND LOCATION ADDRESS 04/01/2013 06/30/2013 09/30/2013 09/30/2013 09/30/2013 Lien Filed With Lien Type 201401126 REVENUE NOTICE OF STATE TAX LIEN ©Register of Deeds ❑Caunly Clerk Original OConlinualion DCorrected 100.00 100.00 100.00 Name KOURTNEY PATCHER Streetor ! er ai ngAddress 1012 WEST 10TH Ity GRAND ISLAND 35,00 35.00 .35.00 No. 3544 P. 2 NE s.. of 1.4a46 Join, a Gels - UCe 3TL 1 1//1111111 iil� I ail � Il !! i 99147312 —a PATCHER KOVRTrlli:y Peg, 1 Filed: 0 2/27/2814 18!61 All PLEASE DO NOT WRITE IN THIS SPACE ion Number octal Secur' Num ` r XXX -XX -8128 County HALL Spouses Social Security umber TAXPAYER NAME AND MAIUNG ADDRESS 3.27 2.53 1.77 Slate NE*. Zip Code 68801 136.27 137.53 136.77 TOTAL $ 412.57 r.hereby cerlltjr That the Nebraska Department of Revenue has compiled with the revenue Taws of the Slate of Nebraska in the datatninetion of the amount shown to be due, and the taxpayer has iled to pay the amount due after demand. If this Notice of Slate Tax Lien is an extension of an affective I{en, k car t continue the prio fg he stele's interest in the affected property of the taxpayer, Revenue Agent sign pa es I nature Title Telephone Number here Revenue Senior Agent - �d L • thorixed Sign re • Title Dale 9181 -1974 Rev. 2-2002 Supersedes 4-4944974 Rot 10 -1595 402 471 -6067.