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Tax Program <br />Tax Period <br />bate of <br />Assessment <br />Tax <br />penalty <br />Interest <br />_ <br />Costs <br />Total Due <br />Sales/Use <br />01/01/2010 - 12/31/2010 <br />08/23/2011 <br />600.00 <br />120.00 <br />84.46 <br />.00 <br />804.46 <br />Sales/Use <br />01/01/2011 - 12/31/2011 <br />08/07/2012 <br />. 710.00 <br />110.00 <br />68.51 <br />.00 <br />968.51 <br />Sales/Use <br />01/01/2012 - 12/31/2012 <br />08/06/2013 <br />940.00 <br />188.00 <br />39.82 <br />.00 <br />1,167.82 <br />Total <br />2,940.79 <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 area 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 Oen.Thls Ilen will expire end <br />become unenforceable 10 years after the date of recording if no <br />continuation statement is recorded on or prior to the expiration of <br />the previous lien or continuation statement. <br />PLEASE 00 NOT WRITE INTHIS SPACE <br />Nebraska ID Number <br />627909 <br />Federal ID Number <br />470412547 <br />Lien Seem Number <br />11467735 <br />Lien Filed Wilk <br />Social Secoky Number <br />Spouse's Social SacuAly Number <br />JJ Iaoglelerof Dews • County Mrs <br />Debi of Lien <br />Ji.iae 19, 2014 <br />Lien Type <br />County <br />HALL <br />® Original • Continuation <br />• Corroded <br />Jul. 2. 2014 3:58PM NE Secretary of State — UCC <br />Nedaellb 0900 , 1191WIT of <br />REVENUE <br />Sign <br />here <br />Business Name and Location Address <br />Ant 'sod Sign <br />Notice of State Tax Lien <br />EAGLES AUXILIARY 378 <br />216E 2ND ST APT 2 <br />GRAND ISLAND NE 68801 <br />No. 5596 P. 3/5 <br />sole - UCC <br />5T` <br />NE See of Maio Jehn P ' l. ,I. <br />Ii � 1 1,1 ��1�' <br />ii <br />i <br />99 370 Post , <br />MiT 8710217814 0215a PM <br />201404050 <br />Taxpayer Name and Mailing Address <br />1 candy that the Nebraska Department of Revenue his complied with the leery of die Slate of Nebraska In determining me amount sboan to be me, <br />uw u .r II,. 1 e ^yew r <br />Iles failed r. Fond). she e.neent hm Aar vlen,.ei.Thie Neei...f OW. an Lion i. on effoeti.. Ilan er.r ..... I. ee.+p..e Rs. pr arty of <br />the . Mere In - I In trio affected property of the taxpayer. <br />/.;(../ di Of 4 . Fr.. <br />Revenue Senior Agent 06/12/2014 402- 471 -5709 <br />Title Oahe Phony Nu r� <br />Revenue Senior Agent f / , <br />This Oils <br />a.54.t itf4 Ann d-2p15 8rgbnedet 4- 40457e A.r. 226 e 2 <br />