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Tax Program <br />Tax Period <br />Date of <br />Assessment <br />Tax <br />Penalty <br />Interest <br />Costs <br />Total Due <br />Sales <br />01/01/2010 - 12/31/2010 <br />08/23/2011 <br />1,040.00 <br />208.00 <br />• 149.79 <br />.00 <br />1,397.79 <br />Sales <br />01/0112011 - 12/31/2011 <br />08/7/2012 <br />_ — 1,300.00 <br />,. 260.00 <br />123,15 <br />.00 <br />1,683.15 <br />Sales <br />01/01/2012 - 12/31/2012 <br />08/6/2013 <br />1,625.00 <br />325.00 <br />74.27 <br />.00 <br />2,024.27 <br />Total <br />5,105.21 <br />This Notice of State Tax Uen 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 deman .These taxes are a Tien for all property located <br />in the county and rights to property owned by the taxpayer or <br />acquired before the expiration of this lien_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 />PLEASE DO NOT WRITE IN /His SPACE <br />Net»Aka tO Number <br />10410023 <br />Federal 0 Number <br />Lien Se,fal Number <br />11437192 <br />Lien Filed Watt <br />fiZ Register of Deeds Q County Clerk <br />Soda) Seaurily Number <br />,. - 6424 <br />Spouses Sodal Security Number <br />County <br />HALL <br />Date of Lien <br />July 30, 2014 <br />Lien T'pe: <br />® Original 0crmanuetion <br />■ corrected <br />Aug. 21. 2014 3:18PM NE Secretary of State — UCC <br />Nebraska Department a1 <br />REVENUE <br />Sign <br />here <br />Business Name and Location Address <br />201405167 <br />Notice of State Tax Lien <br />Taxpayer Name end Matti <br />CORINA VERA <br />2922 S 111TH EAST AVE <br />TULSA 01( 74129 -7821 <br />Revenue Senior Agent <br />Tile <br />Revenue Senior Agent <br />Tile <br />No.6286 P. 3 <br />ei i4ake '" a a.1• - uc <br />1 111111 e .. <br />van mien <br />Filed: eel2112014 0901 AM <br />Address <br />I certify that the Nebraska Department of Peverme has cup lied smelt the laved of the Stale of Nebr'asla in determNbte the amount ahewn to be due. <br />and that the taxpayer ree failed In nay ltd amamt dud arid/ demand. Tho rdnlice at Slate Tali Lien is an effective l an and servo to eorlinue the prioftty of <br />me tales !merest In the affected propeny of the taapa ter. <br />402 -471 -5709 <br />4494 mite, 5-><013 6,t esledes 4449-1574 nee 2.2902 <br />