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Tax Program <br />Tex Period <br />Date of <br />Assessment <br />Tax <br />Penalty <br />Interest <br />Costs <br />Total Due <br />Sales <br />08/01/2013 - 08/31/2013 <br />10/01/2013 <br />.00 <br />25.00 <br />1.67 <br />.00 <br />26.67 <br />Sales <br />09/01/2013 - 09/30/2013 . <br />10/20/2013 <br />.00 <br />.00 <br />3.53 <br />.00 <br />3.53 <br />Sales <br />10/01/2013 - 10/31/2013 <br />12/02/2013 <br />.00 <br />62.76 <br />2.11 <br />.00 <br />64.87 <br />Sales <br />11/01/2013. /2013 <br />01/02/2014 <br />.00 <br />25.00 <br />4,89 <br />.00 <br />29.89 <br />Sales <br />12/01/2013 - 12/31/2013 <br />02/03/2014 <br />.00 <br />63.31 <br />2.60 <br />.00 <br />65.91 <br />Sales <br />01/01/2014 - 01/31/2014 <br />03/03/2014 <br />.00 <br />58.04 <br />1.19 <br />.00 <br />59.23 <br />Sales <br />02/01/2014 - 02/28/2014 <br />03/12/2014 <br />649.27 <br />.00 <br />5.07 <br />.00 <br />654. <br />Sales <br />03/01/2014 - 03/31/2014 <br />05/01/2014 <br />.00 <br />62.51 <br />.82 <br />.00 <br />63.33 <br />Sales <br />04 /01/2014 - 04/30/2014 <br />06/02/2014 <br />741.60 <br />25.00 <br />2.07 <br />.00 <br />768.67 <br />Sales <br />05/01/2014- 05/31/2014 <br />07/01/2014 <br />681.76 <br />25.00 <br />.17 <br />.00 <br />706.93 <br />Total <br />2,443.37 <br />0 <br />Aug, 4, 2014 3:01PM NE Secretary of State - UCC <br />Nrbruake peck entof <br />REVENUE <br />Nebraska 10 Number <br />7009674 <br />Lien Serial Number <br />11488206 <br />Date et Lien <br />June 23, 2014 <br />sign <br />here <br />Lien Filed vino: <br />E Regular of Deeds <br />uen Type: <br />OrgimS <br />Business Name and Location Address <br />Notice of State Tax Lien <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 Iien,This lien will expire and <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 />County Clerk <br />0 Consnu4d4r, <br />PLEASE 00 NOT WRITE IN THIS 5PaCE <br />Federal ID Number <br />470776255 <br />Social Ssecurky Number <br />RAC XX -9068 <br />Deorr4dua <br />DENNIS NELSON <br />501N PINE ST <br />GRAND ISLAND NE 68801 <br />Na, 6022 P. 4 <br />se Soo of s4sio Jah+ A fi.ir - ucc an. <br />" 1111111 : 1 1 <br />11111 <br />99 14739811.1-8 <br />NELSON aErars Pea. 1 <br />Filed; Se/S4/2814 09;42 pp <br />Courtly <br />HALL <br />201404820 <br />Spouse's scowl security Number <br />Taxpayer Name and Mailing Address <br />1 Gerdy tat the Nebraska Depatlmenl of Revenue has complied wgh the lava of the State of Nebraska in delrsnnining the amount shown to be due, <br />and Mal Ma taxpayer has felled to pay the amount due attar demand. Trig Notice of Stela Taw Liao la art erteCKwe San end sees to oontinua the priority of <br />the Sl interest in the anuses pro. = •: /he ma ayer. <br />ramie* <br />Signature <br />valorized Signature <br />Revenue Agent <br />Tole <br />Revenue Senior Merit <br />illle <br />07/28/2014 <br />Oats <br />402 - 471 -6067 <br />Phone Number <br />Date <br />4491.11174 Ner eal Supersedes 4.949.19)4 Rau, 2 -2p02 <br />S1 <br />