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Tat Program Tex Period .. _.. . Date of A + nerd . Tax . Penalty Interact Costs Total Due _ .. ..... . Sales 111 i'2010— 17J31/2010 07/0912013 729.51 185.90 126.26 - -� — — — 1,041.67 Sales 1/1/2011- 12/31/2011 07/09/2013 0.00 25.00 0.00 25.00 Total 1.066.67 Jun, 20, 2014 2:40PM NE Secretary of State — UCC No 5420 Nebraska Department of REVENUE This Notice of State Tax Lien is issued by the Nebraska Department of Revenue for unpaid taxes h1,dmInleterad by the Tex Commissioner. Taxes, Including penalties, interest, and costs, which are shown below, are due from the taxpayer and remain unpaid after demand. These taxes are a iten for all property located in the county and rights to property owned by the taxpayer or acquired before the expiration of this lien. This lion will expire and become unenforceable 10 years after the date of recording if no continuation statement is recorded on or prior to the expiration of the previous lien or continuation statement. Nekrsrka ID Number 9919465 Lien at Number Date of Lien sign * here 1/ 35 06122014 Lien Fled Ath Lien Type BUSINESS NAME AND LOCATION ADDRESS 2014037'19 Notice of State Tax Lien Register of Deeds 0 County Cierit ©Original ❑Cattinuabort ❑Corrected Title Revenue Senior Agent Title Federal ID Number PLEASE DO NOT WRITE IN THIS SPACE My umber XXX -XX -1158 County HALL TAXPAYER NAME AND MAIUNC ADDRESS APRIL KOEHLER 3232 S CLIFTON AVE, LOT 424 WICHITA KS I certify tat the Nebrasita Department of Revenue has complied with the Taws of the State of NObraska in the determining the amount shown to be due, and that the taxpayer has failed to pay the amount due after demand. This Notice of State Tax Lien Is en effective tan and serves to continue the priority of the State a interest in the affected property of the taxpayer. Revenue Senior Agent r 9514737717 -5 Pea: 1 noun ARIL Filed: 06l2e1201i 02:18 PM Spouse's Social Seahriiy Number 402 471 -5709 Phone N robed Date 4- 494-104 Rev. I- 2013 Milan 44641x74 me, 2.t002 57218