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Tax <br />Program <br />Ted Period <br />Pete et <br />Aaaeaeraent <br />Tex <br />Penalty <br />Inte eat <br />f�ni19 <br />Told Due <br />Individual <br />2009 <br />0610312012 <br />422.86 <br />21.13 <br />78.29 <br />522.08 <br />Total <br />$522.08 <br />. Sep. 4, 2014' 2:30PM NE Secretary of State — UCC <br />Neerub. Depanmenr al <br />REVENUE <br />This Notice of Site Tax Lien le Issued by the Nebraska <br />Department of Revenue for unpaid taxes administered by the Tax <br />Commissioner. Taxes, including PRIMMER, interest, and coats, <br />which are shown below, are due from the taxpayer and remain <br />unpaid after domend.Theee taxes are a lien for all property located <br />In the county and rights to property owned by the taxpayer or <br />acquired before the expindion of this Iien.Thts 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 />r <br />Nets D Number <br />42428785 <br />Uen Seed Number IJen Red tNiP: <br />11438817 ® Reedier of Deeds ❑ County Clete <br />1)1 err' Lien Typo: <br />0812512014 ® Original ❑ Contie'alb" <br />Business Name and Location Address <br />sign <br />here <br />Notice of State Tax Lien <br />¢LEASE 00 NOT WRITE IN THIS SPACE <br />feral ID number <br />Social Security Number <br />XXX -XX -0626 <br />❑ <br />Corroded <br />PLEASE RETURN TO: <br />' NEBRASKA DEPT OF REVENUE <br />PO BOX 94609 <br />LINCOLN NE 68509 -4609 <br />Spouset Social Seedily Murder <br />coum <br />HAU. <br />No. 6496 <br />Taxpayer Name and Mailing Address <br />THOMAS R TillPEK <br />108W10THST <br />GRAND ISLAND NE 68801.3651 <br />Nr sac of ;si JeglIn a cal• - uc; sr4 <br />Il,i'I <br />fl n �I II <br />" III <br />PI III/1111 ' <br />2914741881 - 6 Pas; t <br />Fi1� d9 i 4% / WIG AM <br />201405524 <br />Inertly That the NebraaNa Deportment of Fievenue hue complied ale lows oldie State of Neb,aeke'r, determining rt19 alnuuul shown to be dua <br />end Seal pie taxpeyar nee _ ", the amount due after dement This Neese of Stole Tax Un is on elledtvo run ford serves to aortede the primly of <br />me $tote's intend in file <br />