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Tax <br />Pimp= <br />Tax Polled <br />Date al <br />Assessment <br />Tax <br />Penalty <br />imams <br />Coda <br />Total Due <br />Individual <br />2009 <br />11107/2012 <br />326.39 <br />10.27 <br />67.9T <br />409.63 <br />Individual <br />2010 <br />05113/2013 <br />230.29 <br />11.91 <br />37.87 <br />288.1)7 <br />Individual <br />2011 <br />0611412012 <br />91.00 <br />4.55 <br />9.90 <br />105.45 <br />7 <br />Total <br />$803.15 <br />cp <br />Jun. 17, 20 3:24PM NE Secretary of State — UCC <br />PLEASE RETURN TO: <br />NEBRASKA DEPT Of REVENUE <br />PO BOX 94609 <br />LINCOLN NE 68509 -4609 <br />ndm De� rrmeel of <br />REVENUE <br />This Notice of State Tax ban 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 ere shown below, are due from tha taxpayer and remain <br />unpaid after demand.These taxes are a Tien 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 10 years after the data 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 IP Number <br />96801743 <br />Lien Serail Number <br />11552827 <br />Dye of . <br />06/0912015 <br />sign <br />here <br />aultxaaed Sigmeure <br />Ue i F11edWar <br />Uen Type: <br />mod <br />Business Name and Location Address <br />® Register drDee ❑County Cleat <br />201504072 <br />Notice of State Tax Lien <br />❑ tonlllwalon <br />PLEASE D0 NOT WRITE IN Tres SPACE <br />Federal ID monitor <br />Cold Semite Number <br />70O 7X4494 <br />❑careered <br />CHARLES H NICHOLS.JR <br />106 WETZEL ST <br />GRAND ISLAND NE 68801 <br />M E Sec e1 at.ti aenr, H - ACC !TL <br />1111 111 <br />9915758134 -4 W: <br />NIcI*I5 CHARLES H JR <br />Filed: 06117/2015 02:39 PH <br />Spawek Sadsl %curt, Number <br />Crony <br />HALL <br />Taxpayer Name and Mating Address <br />or Roomuo Its, Campted eeA the rear et the SIale or NBbraEtra n oaremaring rte amours shown to be der, <br />the amount dud Bite dermal Wake at Slate Tan Lien as an of dive err and sane& t menus the prlully at <br />pmpely or rho imam. <br />No, 1336 P, 3/3 <br />!3001632 -1210 <br />Phone liaubet <br />0810912015 <br />dale <br />4- 464-1174 Rot. B-2e10 6,peraeon 44411-1071 Rrn.2 -2e02 <br />�0 <br />