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Tax <br />Program <br />Tax Period <br />Date of <br />Assessment <br />Tax <br />Penalty <br />Interest <br />Costs <br />Total Due n <br />wittookn� <br />10/01/2011 <br />12/3112011 <br />04/10/201 <br />405.00 <br />100.00 <br />34.45 <br />539.45 <br />vnthho1ding <br />07/01/2012 <br />09130/2012 <br />03/26/2014 <br />220.08 <br />55.02 <br />10.43 <br />285.53 <br />IMthrtodl� <br />1 oro1no12 <br />12131/2012 <br />03/26/2014 <br />169.71 <br />42.43 <br />6.19 <br />218.33 <br />Total <br />1,043.31 <br />May. 5. 2014 3:49PM NE Secretary of State — UCC • No. 4654 P, 3/7 <br />Nebraska Department of <br />REVENUE <br />This Notice of Slate 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 />Hen For ell property located in the county and rights to property owned by <br />the taxpayer or acquired before the expiration of this Nan. This Ilan will <br />expire and become unenforceable 10 years after the date of recording <br />it no continuation statement is recorded on or odor to the expiration of <br />the previous lion or continuation statement. <br />Nebreeka ID Number <br />uen d Number <br />sign <br />here <br />8960216 <br />17 f50 <br />Date of Lien <br />04/20/2014 <br />BUSINEss NAME AND <br />.4 <br />Sicnatu <br />Lien f=iled Wikh <br />Register of Deeds ❑County Clerk <br />Lien Type <br />©Oriprtal ❑Continuation D Corrected <br />LOCATION ADDRESS <br />The <br />Revenue Senior Agent <br />Notice of State Tax Lien <br />The <br />201402688 <br />Federal ID Number <br />20-0787306 <br />PLEASE DO NOT WRITE IN TI4S SPACE <br />Social Security Number <br />XXX XX -1326 <br />County <br />HALL <br />TAXPAYER NAME AND MAILING ADDRESS <br />RYAN BARTELS <br />2416 OVERLAND TRAILS CIR <br />GRAND ISLAND NE <br />PE 9.e .t Skr4 John Asia - UCC 5T <br />9914735400 —a Path i <br />BARTELS RYAN <br />F/Ied; e5/8512e14 x2;55 Pn <br />Spwiee'a Social Security Number <br />I certify that the Nebreska Deper n ant of Revenue has compiled with the lawn of the State of Nebracln in the determining the amount shown <br />to be due, and that the taxpayer has failed to , la amount due after demand. This Notice of State Tax Uen Is an effective lion and serves <br />to continue the jr e Sbtars interest Netted property of the i ixpayer. <br />` Revenue Agent <br />Date <br />4- 1194.19r4 MV. 11-2019 SuIIriean 4d94-1974 Rev. 2.2002 <br />68802 <br />402 471 -6067 <br />Phone Number <br />