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Tax <br />Program <br />Tax Period <br />Date of <br />ARiasament <br />Tax <br />Penalty <br />Intermit <br />Costs <br />Total Due <br />� <br />Withholding <br />10/01/2010 <br />12/31/2010 <br />03/1412014 <br />527,26 <br />105.45 <br />69.98 <br />702.69 <br />Wilhhoi dino <br />0101/2011 <br />12131 /2011 <br />03/14/2014 <br />2,953.85 <br />255.86 <br />294.07 <br />3,503.78 <br />1 <br />withholding <br />0110112012 <br />09/30/2012 <br />03/14/2014 <br />2,509.19 <br />5 536.33 <br />168.42 <br />3.213,94 <br />_ — <br />Litter Fee <br />01/01/2008 <br />1 <br />03/14/2014 <br />342.14 <br />75.00 <br />60.04 <br />477.18 <br />Total <br />1,897.59 <br />Mar. 28. 2014 3.08PM NE :secretary of State — UCC <br />Nebraska Department of <br />REVENUE <br />Thls Notice of State Tax Lien is issued by the Nebraska Department of <br />Revenue for unpaid taxes administered by the Tax Commissioner- Taxes, <br />Including penalties, interest, and costs, which are shown below, are due <br />from the taxpayer and remain unpaid after demand. These taxes are a <br />lien for all property located in the county and rights to property owned by <br />the taxpayer or acquired before the expiration of this lien. This Ilen will <br />expire end become unenforceable 10 years after the date of recording <br />if no continuation statement Is recorded an or prior to the expiration of <br />the previous lien or continuation statement. <br />Nebraska ID Number <br />10155511 <br />Li en aria! Number <br />I / / /£if - 4 <br />Date of Lien <br />sign <br />hero <br />03/24/2014 <br />BUSINESS NANE AND LOCATION ADDRESS <br />Notice of State Tax Lien <br />Federal ID Number <br />Lien Filed With <br />MIRegistsr f]County Clerk <br />Lien Type <br />®Original DContinuation OCorrecisd <br />Tine <br />Revenue Senior Agent <br />Tills <br />No. 4021 <br />201401745 <br />PLEASE DO NOT WRITE IN THIS SPACE <br />Social Security Number <br />XXX -XX -4498 <br />County <br />HALL <br />TAXPAYER NAME AND MAILING ADDIgE$S <br />KIMBERLY A. WISEMAN <br />103 BEACI -IWOOD DRIVE <br />GRAND IS LAND <br />I certify that the Nebraska Deperbhent of Revenue hes complied with the laws of the State of Nebraska in the determining the amount shown <br />to to due, and that the Iaxpayer has failed to pay the amount due after demand. Thls Notice of State Tax Lien is an effective lien and serves <br />to continue the . . . the State's inter =.may the affected property of the taxpayer. <br />Revenue Agent <br />9729 51 <br />t ' 111 11 irk <br />Pee: 1 <br />F11edd a AM <br />Spouse's Social Security Number <br />NE <br />Phone Number <br />Pate <br />4 -4e4.1974 Rev. 62619 Supersedes 4Je1.1e74 Rev. 2.2002 <br />68803 <br />402 471 -6067 <br />ly <br />