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Tax Program <br />Tax Period <br />Date of <br />Assessment <br />Tax <br />Penally <br />Interest <br />Costs <br />Total Due <br />Sales/Use <br />08/01 /2012 - 08/31/2012 <br />10/01/2012 <br />345.97 <br />34.60 <br />20.16 <br />.00 <br />r- 400.73 <br />Sales/Use <br />10/01/2012- 10/31/2012 <br />12/03/2012 <br />.00 <br />48.06 <br />3.05 <br />.00 <br />51.11 <br />Sales/Use <br />11/01/2012 - 1I/30/2012 <br />01/02/2013 <br />.00 <br />38.05 <br />.85 <br />.00 <br />38.90 <br />Sales/Use <br />12/01/2012 - 12/31/2012 <br />01/20/2013 <br />280.86 <br />.00 <br />11,98 <br />.00 <br />292.94 <br />Sales/Use <br />01/01/2013 - 01/31/2013 <br />03/01 /2013 <br />.00 <br />43.52 <br />.54 <br />,00 <br />44.06 <br />Sales/Use <br />02/01/2013 - 02/213/2013 <br />04/01/2013 <br />646.00 <br />25.00 <br />24.42 <br />.00 <br />6 <br />Sales/Use <br />03/01/2013 - 03/31/2013 <br />05/01/2013 <br />.00 <br />76.57 <br />2.77 <br />.00 <br />79.34 <br />Sales/Use <br />04/01/2013 - 04/30/2013 <br />05/14/2013 <br />.00 <br />74.31 <br />1.71 <br />.00 <br />76.02 <br />Sales/Use <br />05/01/2013 - 05/31/2013 <br />06/16/2013 <br />.00 <br />.00 <br />1.17 <br />.00 <br />1.17 <br />Sales/Use <br />06/01/2013 - 06/30/2013 <br />07/20/201 <br />.00 <br />.1)0 <br />.96 <br />.00 <br />.96 <br />Sales/Use <br />07/01/2013 - 07/31/2013 <br />09/03/2013 <br />.00 <br />25.00 <br />1.17 <br />.00 <br />26.17 <br />Total <br />1,706.72 <br />1J' <br />Aug. 4, 2014 3:00PM NE Secretary of State - UCC <br />nretrarf a 0. 'b' ent of <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 lion for all property located <br />in the county and rights to property owned by the taxpayer or <br />acquired before the expiration of this Iisn.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 />Nebraska Ip Number <br />7009674 <br />Len Serial Number <br />11487781 <br />Date of Lien <br />'tune 23, 2014 <br />sign <br />here <br />Lien Type: <br />IJ Orginal <br />Business Name and Location Address <br />Notice of State Tax Lien <br />Lien Flied Wen: <br />�[J Repieisr of Deeds 0 County Clerk <br />❑ Continuation <br />Corrected <br />Federal ID Number <br />470776255 <br />Social Ocelot). Number <br />7 -X -9068 <br />Revenue Afr <br />Signature Ttte <br />Revenue Senior Agent <br />%honeed Signature Title <br />PLEASE DO NOT WRITE IN THIS SPACE <br />NE Sae of Sk.aa .1a,... 11 - UCC an <br />11 1111111111 11 <br />I <br />9014739635 -3 Pgs; 1 <br />NcIpSON DEARI5 <br />Flied: 08 09:42 API <br />Spotxle & Sacle *amity Number <br />county <br />14&x L <br />DENNIS NELSON <br />501 N PINE ST <br />GRAND ISLAND NE 68801 <br />No. 6022 P. 2 <br />Taxpayer Name and Malkin • Address <br />201 404822 <br />i cerllly that The Nebreeke Department of Pevenue has complied with the lane of the Slate of Nebraska In determining the amount shown b be due, <br />and that the la ayer has failed to pay the amount due alter demand. This Notice of Slate Tax Lien Is an effect lve lien and servos to continue Inn priority Al <br />the 5taJkrsift eaI In the affected prof the taxpayer. <br />07/28/2014 402 -471 -6067 <br />Dale Phone Number <br />7-01-94/ <br />Cale <br />4-4941974 het e4010 supersedes 4019.1974 P. 2.2002 <br />