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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 />08/0112013 - 08/31/2013 <br />05/17/2014 <br />85.67 <br />33.59 <br />2.36 <br />.00 <br />121.62 <br />Total <br />12I.62 <br />Sep. 5 2014 2:39Pv1 • NE Secretary of State — UCC <br />Nebraska Cepartmert of <br />REVENUE <br />This Notice at State Tax Lien Is Issued by the Nebraska <br />Department 01 Revenue for unpaid taxee.adminlatered by the Tax <br />Commissioner. Taxes, Including penalties, interest, and coats, <br />which are shown below, are due from the taxpayer and remain <br />unpaid after demand.Thess taxes are a Den 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 lo 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 ID Number <br />10162291 <br />LIen Serial Number <br />1 ,'s': <br />Len Flied Wilt: <br />® Register 01 Deeds ❑ County Carly <br />Business Name and Location Addreas <br />sign <br />here arers nature <br />wind Sf4n9tufe <br />2011955 61 <br />Notice of State Tax Lien <br />Revenue Agent <br />PLEASE DO NOT WRITE IN THIS SPACE <br />Federal ID Number <br />Social Security Number <br />XYCX -XX -0303 <br />Tire <br />Revenue Senior Agent <br />TII)e <br />DELMI RODRIGU .Z <br />1701 'W 1ST ST <br />GRAND ISY.A.NI NB 68803 <br />No, 6535 P. 2 <br />NC tae a State Jahn a a.l• - VCC Sat <br />9814741452 -.9 Pei ; 1 <br />ROORICUEZ ihF1nl <br />riles 14 10:34 fall <br />poyge's Social Security Number <br />County <br />Dale of Lien Lienlyper <br />August 20, 2014 ® original ❑ ConNnuatIon ❑Corrected BALL <br />Taxpayer Name and Mailing Address <br />1 os1i1y Met the Nebrealra Department of Revenue hes sordpllod w;et Inc laws of the awe of Nebraska h determining the amount shown to be due. <br />and that the lakpeyar has !area to pay the amount due attar demand. Thee HORN of We Tea Wm Is an effective [fen stud senora to continua the priority of <br />the deist Interest in the elected prglprty or the taxpayer. <br />Cate Rhone Number <br />09/03/2014 402.471 -6067 <br />Dale <br />4.84.1974 RM. 0.2013 ever a tees 4449.1 e74 P. �• <br />