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Tax <br />Program <br />Tax Period <br />Date of <br />Aa essment <br />Tax <br />Penalty <br />interest <br />Costs <br />Total Due <br />Sales <br />08/01/2010 <br />08/31/2010 <br />03/14/2014 <br />2,710.57 <br />271.05 <br />407.26 <br />3,388.89 <br />Sales <br />10101 /2010 <br />01/31/2011 <br />03/14/2014 <br />8,668.07 <br />866.82 <br />1,184,39 <br />10,719.28 <br />Sales <br />06/01/2011 <br />06/31/2012 <br />03/14/2014 <br />9,296.11 <br />1,273.48 <br />811.20 <br />11,380.79 <br />Sales <br />07101@012 <br />08131/2012 <br />03/14/2014 <br />0.00 <br />61.40 <br />0.20 <br />61.60 <br />. <br />Sales <br />10/01/2012 <br />11/30/2012 <br />03/14/2014 <br />788.85 <br />139.98 <br />33.32 <br />980.15 <br />Sales <br />01101/2013 <br />02/28/2013 <br />03/14/2014 <br />0.00 <br />50.00 <br />0.04 <br />50.04 <br />Total <br />213,560.75 <br />Mar, 200, 2014 3:09PM NE Secretary of State — UCC <br />Nebraska Department of <br />REVENUE <br />Nebraska ID Number <br />10155611 <br />err . i 'umber <br />Date of lien <br />here <br />Lien Type <br />Original Continuation <br />BUSINESS NAME AND LOCATION ADDRLSS <br />03/24/2014 <br />sign w Preparers5ignatue <br />Notice of State Tax Lien <br />This Notice of State Tax Lien ie issued by the Nebraska Department of <br />Revenue for unpald taxes administered by the Tarr Commissioner. Taxes, <br />including penalties, interest, and covets, which are shown below, are due <br />from the taxpayer and remain unpaid after demand, These taxes are a <br />Mien 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 lien will <br />expire and become unenforceable 10 years after the date of recording <br />if no continuation statement is recorded on or prior to the expiration of <br />the previous Hen or continuation statement <br />Len d ad rm <br />'Federal ID Number <br />©Replster of Deeds DCcunty Clerk <br />Revenue Agent <br />Title <br />Social Security Number <br />XXX XX-4498 <br />Deorrectea <br />Revenue Sen Age <br />Title <br />PLEASE DO NOT WRITE IN THIS SPACE <br />County <br />HALL <br />TAXPAYER NAME AfilD MAILING ADDRESS <br />KIMBERLY A. WISEMAN <br />103 BEACHWOOD DRIVE <br />GRAND ISLAND <br />NE Sic of Stoke John N O.rr - LICE ETL <br />9914732952 -8 Pea: 1 <br />w ;KfrMAN KIMBERLY A. <br />Filed: D3/2612014 1i156 All <br />No. 4021 P, 5 <br />201401746 <br />Spouse's Social Seca ty N <br />NE <br />I certify that the Nebraska Department of Revenue has complied with the laws of the Slab of Nebraska in the delarmininp the amount shown <br />20 be due, and that the taxpayer has Nailed to pay the amount due after demand. This Notice of State Tax Lien Is an effective lien and serves <br />to continue the priories of the Stales Interee)lIfthe affected property of the taxpayer. <br />Pho ne Number <br />bate <br />4-49+1974 ReV. 8.2018 somas 4 -194-1974 Rev. 2-2002 <br />68803 <br />402 471 -8067 <br />3_21- --/y <br />