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Tax Program <br />Tax Period <br />Date of <br />Assessment <br />Tax <br />Penalty <br />Interest <br />Costs <br />Total Doe <br />Sales <br />09/01/2017 - 10/31/2012 <br />12/03/2012 <br />.00 <br />.00 <br />.20 <br />.00 <br />.20 <br />Sales <br />12/01/2012 - 01/31/2013 <br />03/01/2013 <br />.00 <br />6.57 <br />.05 <br />.00 <br />6.62 <br />Sales <br />02/01t2013 - 03/31/2013 <br />05/01/2013 <br />.00 <br />50.00 <br />.07 <br />_00 <br />50.07 <br />Sales <br />05/01/2013 - 05/31/2013 <br />07/01/2013 <br />.00 <br />25.00 <br />.66 <br />_00 <br />25.66 <br />Sales <br />06/01/2013.06/30 /2013 <br />09/03/2013 <br />.00 <br />25.00 <br />.75 <br />• .00 <br />25.75 <br />Sales <br />07/01/2013 - 02/28/2014 <br />06/15/2014 <br />51.90 <br />220.00 <br />5.50 <br />.00 <br />277.40 <br />Sales <br />03/01 /2014 - 12/31/2014 <br />02/02/2015 <br />678.40 <br />225.00 <br />13.95 <br />.00 <br />917.35 <br />Total <br />1,303.05 <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, induding penalties, interest, and costs, <br />which are shown below, are due from the taxpayer and remain <br />unpaid after demand.These 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 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 on NOT WIirrE IN THIS SPACE <br />N.brarka ID Number <br />11335114 <br />Federal ID Number <br />454543472 <br />Lien Sell Number <br />11592756 <br />lion Red War: <br />Solt Sacurey Number <br />YCIX. XX 2554 <br />Spouse's Social Socially Number <br />E7 mister of Peadh 0 count CI0A1 <br />Date al Lien <br />May 20, 2015 <br />Lien Type: <br />❑ corrodea <br />County <br />HALL <br />1 ! orignat ❑ coni nueron <br />o� <br />Jun. 4. 2015 3:45PM NE Secretary cf State - UCC No, 1146 P. 5/6 <br />Natxaeka Deprmierri of <br />REVENUE <br />Business Name and Location Address <br />201503722 <br />Notice of State Tax Lien <br />WAYNE OSGOOD <br />PO BOX 5882 <br />GRAND ISLAND NE 68802 <br />e aerie <br />Me See If atefa Joke <br />9915755475.4 Peet 1 <br />MOOD HONE <br />Fllad: male4JFe15 02:44 pM <br />Taxpayer Name and Mailing Address <br />Ucc <br />en. <br />I early err ale Nebraska Depennent of Revenue ire oompbed with Om laws of the Sen. of Nebraska In deatrmining ilia amount shown b be duo, <br />alp url t empayer flea sled to the amount duo ghee demend.The Notice el lime The lion le en Oleodve lion and amuse to continue me piorey or <br />the S rest to To aped y orR a taxpayer. <br />sign, ,, 1/ 1L+Wa�urIl se as - 4"714067 <br />here PriCil atpnrure Y,» <br />na <br />Revenue SMUT Agent <br />limbed Signeb Y1se <br />Dale prior rumwr <br />Dee <br />4494 -1874 Rat 9.2013 SiaM5edes 1.949.1971 Rev. 2 - <br />