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Prt gram <br />TUX Period <br />Asa> tMant <br />TeX <br />Penally <br />Menial <br />Casts <br />TOW Due <br />Individual <br />2012 <br />05/1012013 <br />915.00 <br />175.25 <br />72.73 <br />1,162.98 <br />Total <br />$1,16288 <br />Mar, 18, 2015 3:03PM NE Secretary of State — UCC <br />Z;tf <br />N�A.Ye t4pertmenr cr <br />REVENUE <br />Nebraska ID Number <br />31518072 <br />Lien Set al Number <br />11548401 <br />Dere of Lion <br />03/1112015 <br />!iisinnaa Maine end Location Mites <br />201 501617 <br />Notice of State Tax Lien <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 Mow, are due from the taxpayer and remain <br />unpaid after demand.These talxea are a Hen tor all property located <br />in the county and rights to property owned by the Taxpayer or <br />acquired before the expiration of this Tien -This lien will expire and <br />become unenforceable 10 years after the date of recording If no <br />continuation statement Is recorded an or prior to the expiration of <br />the previous lien or continuation statement <br />Lien Filed Welk <br />® flegsler of Deeds D County Clerk <br />Federal IP Number <br />seas 5E404 Number <br />XXX X111.0434 <br />Uoil <br />®orignal ❑ GonUn talon Q Corroded <br />AMI L WELLER <br />415 5 CHERRY ST APT Al <br />GRAND ISLAND NE 681101 <br />°sentry <br />HALL <br />IE Sec of Stele Jahn it 4+111 - set STL <br />1111111 <br />9915759614.6 PP: <br />MELLER Arai <br />Fi1�d: 53/1 118.40 fit <br />No. 9727 P. 2'4 <br />PLEASE DO NOT WRITE INTHIS SPACE <br />PLEASE RETURN TO; <br />' NEBRASKA DEPT OF REVENUE <br />PO BOX 94609 <br />LINCOLN NE 68509 -4609 <br />Spouse's Social Secieby <br />Taxpayer Name and Mailing Address <br />1 Gently ui.i he Nebraska Deperlmenl or Revenue has oorrrp'rad with fro Ian of the 13We et Nebraska in delemirig tie anmrue shown to be due, <br />end Ihal pie laripa)er Io pay the serum due otter derrwrld Thls Node or Stele Teo Lien h an efeoive ten and awes Io oath* die pawky <br />Ike Skeet inroad y , , • r:: s . • <br />Revenue Agent 03111/2015 11308) 3212 x6 <br />Tea Dale Pfwne Number • <br />Revenue Supervisor 03/1112015 <br />Tire Dale <br />44041014 Rea 02019 Suposedra 0444074 Rau. 2.= <br />