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ax P T e n <br />Tax Period <br />Assessment <br />Tax <br />Penalty <br />Internet <br />Cools <br />Tots' Due <br />Individual <br />2000 <br />03/1512012 <br />247.18 <br />12.36 <br />56.36 <br />315.92 <br />Total <br />$315.92 <br />Jun, 2, 2014 3:19PM NE Secretary of State — UCC <br />PLEASE RETURN TO: <br />NEBRASKA DEPT OF REVENUE <br />PO BOX 94609 <br />LINCOLN NE 685094609 <br />Nebraska Department el <br />REVENUE <br />This Notice of State Tax Lien is issued by the Nebraska <br />Department of Revenue for unpaid taxes administered by the Tax <br />Commissioner. Taxes, including penalties, interest, and costs, <br />which are shown below, are due from the taxpayer and remain <br />unpaid after demand, These taxes are a lien for all property located <br />In the county 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 after tha data of tecordtng if no <br />continuation statement is recorded on or prior to the expiration of <br />the previous lien or contlnuaflon statement <br />Nebraska ID Nuber <br />;2911906 <br />Lien Serial Number <br />11434563 <br />Data d Lien <br />05/30/2014 <br />sign <br />here <br />Ieeniy <br />End ha <br />rte Slete s <br />Notice of State Tax Lien <br />Lien Riad Wilk: <br />J Register of Deeds DGounY Clerk <br />ten Typc <br />® Orlphul <br />Business Name and Locedon Addres <br />� Continuation <br />PLEASE DO NOT WRITE Pi INS SPACE <br />Federal ID Number <br />Sold Security Number <br />xxx.xX .a116 <br />Copy <br />❑Careaea HALL <br />Taxpayer Name and UaINn , Address <br />JODI R LANG <br />3761 DEERWOOD AVE <br />GRAND ISLAND NE 68803 <br />Revenue Agent <br />Revenue Supervisor <br />No, 5022 P, 3/5 <br />k <br />111111111 ff &4/...0 S Jahn A meta - LJCC sit <br />lei ' trite <br />101 11 <br />J I 0 <br />9 934736042 -3 Pas: 1 <br />LANs JODI R <br />Flied: (1610212814 11,90 DM <br />Spots Social Security Number <br />has oom peed wllh Use Iona 01 the Stale of Nebraska in delermhing the amount Moan to he due, <br />Me attar demand. This Make of 5Iate lhn lien la an effect* Yen aM somas to nentlrare the glo *y et <br />WIPE <br />2 01403261 <br />(30)632 -1210 <br />4-494974 Rea 12013 8.pree4ee 49404974 Ret 24002 <br />