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Tax Program <br />Tarry Period <br />Date of <br />Assessment <br />Tax <br />Penalty <br />Interest <br />Costs <br />Total Due <br />Withholding <br />10/01/2009 - 12/31/2009 <br />03/24/2013 <br />.00 <br />26337 <br />12.27 <br />100.00 <br />375.64 <br />Withholding <br />01/01/2011- 06/3W2011 <br />03/24/2013 <br />7,98530 <br />924.37 <br />1,191.16 <br />.00 <br />. 10,100.83 <br />Withholding <br />07/01/2010.12/31 /2010 <br />03/24/2013 <br />9,100.00 <br />3,185.00 <br />1,618.69 <br />.00 <br />13,903.69 <br />Total <br />24,380.16 <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 dernend.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 />became 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 DO NOY WRrf'E IN THIS SPADE <br />_ <br />Nebraska ID Number <br />981_9139 <br />Federal ID Number <br />X73399 <br />Lien se,w Number <br />11592493 <br />Lien riled With <br />Social Security Number <br />7LXX XX - 8857 <br />Spouse's SCCYd SeCCAty Number <br />riff Register of Deeds • County r <br />Pete al <br />April 29, 2015 <br />UM Ayr <br />0Cousaled <br />County <br />BALL <br />® Original • Conthtasaon <br />Jun, 4, 2015 3:45PM NE Secretary of State — UCC <br />REVENUE <br />sign <br />here <br />Business Name and Location Address <br />201503723 <br />Notice of State Tax Lien <br />Bemuse Amen <br />Thke <br />Revenue Senior Agent <br />VONNiB D. WHITE <br />201 N FIRST ST <br />DONIPHAN NE 68832 <br />No. 1146 P, 4/6 <br />sot.a <br />e aa8• - : u G w, <br />I pi Meta <br />NNW p . <br />WHITE N WD, <br />Filed/ t rile 82 a Pti <br />Taxpayer Neme and Mailing Address <br />1 ea ly that the Nebraska Oeprtmeni of Revenue has coupled with the laws el the Stele of Hobreeke in determining the amount shown to be due, <br />Crrd'hgl me r hoe felled In pay um due ahr demand. This Nair of State Tao Lien is an efleodte lion end serves to continue the priority or <br />a+a S y"�' in ew attacks, . the Ue3lps er. <br />■ <br />-�� 0 6r -- 402- 471 -6067 <br />Phone Number <br />h y ~r / <br />' (,� <br />Dale <br />4.04.1974 Rat. .4013 supaIus ;r•1871 f1044 <br />