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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 />07/01/2013 .03/31/2014 <br />07/07/2014 <br />917.73 <br />257.86 <br />31.32 <br />.00 <br />1,206.91 <br />Withholding <br />01/01/2013 - 12/31/2013 <br />07/07/2014 <br />660.00 <br />198.00 <br />16.00 <br />.00 <br />874.00 <br />Total <br />2,080.91 <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 end 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 />PLEASE CID NOT WRITE INTHIS SPACE <br />Nebraska ID Number <br />8300461 <br />Federal ID Number <br />47082(1027 <br />Uen Serial Number <br />11490354 <br />Lien Filed Wilk <br />Social Secuky Number <br />.X3C 7t -8435 <br />Spouse's Social Security Number <br />R Register* Deeds ❑CountyClertt <br />Dais of Lien <br />November 18, 2014 <br />Lien Type: <br />County <br />HALL <br />F i origmd ■ Conitnuelon <br />• Corroded <br />Dec. 5 2014 2:48PM NE Secretary of State - UCC <br />r abrpake Oepartment Of <br />REVENUE <br />I Certify Mal me Nebraska Department or Revenue nos complied will me laws of me Stale o1 Nebraska in deiarmininp the amount shown to be due. <br />and Out the taxpayer has ratted to pay the amount due eller demand This Notice at stale Tax Lien Is an effective Nen end serves to continue the priority 91 <br />the 'e interest in the effected Iy of the taxpayer. <br />me end Location Address Taxpayer Name and Malin a Address <br />PHILLIP L WATTS <br />PO BOX 235 <br />WOOD RIVER WE 68883 <br />sign L r <br />here P rare si <br />Ihorised Signature <br />201407661 <br />Notice of State Tax Lien <br />Revenue Agent <br />Tills <br />Revenue Senior Agent <br />Pie <br />No. $049 P. 2 <br />NE Sea -f S! -r Arm P is.e • LICE sTL <br />IIllhIII I <br />921474$9111-3 Psi. 1 <br />WATTS PHILLIP L <br />Filed: 12 /05!2014 09;00 /N1 <br />12/91/2014 902- 471 -6067 <br />Dale Phone Number <br />r).-1- <br />bale <br />4.04.1974 Aev s.7eua gupeeedsn 4-215 -1974 Reg 2 <br />