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Tax Program Tax Period Asseassmenl Tex Penalty Interest Costs Total Due Individual 2013 05/02/2014 409.00 20.45 14.82 444.27 Total $444.27 Jul. 7. 2015 3:17FN PLEASE RETURN TO: NEBRASKA DEPT OF REVENUE PO BOX 94609 LINCOLN NE 68509 -4609 Nebraska Department of REVENUE This Notice of State Tax Lien is issued by the Nebraska Department of Revenue for unpaid taxes administered by the Tax Commissioner. Taxes, including penalties, Interest, and costs, which are shown below, are due from the taxpayer and remain unpaid after demand.These taxes are a lien for all property located in the county and rights to property owned by the taxpayer or acquired before the expiration of this lien.Thls lien will expire and become unenforceable 10 years after the date of recording if no continuation statement is recorded on or prior to the expiration of the previous lien or continuation statement. Nebrs5la ID Number 96442530 lien Serial Number 11553805 Dale of Lien 06/30/2015 sign here Business Name and Location Address Ices and Iha the 91 afore NE Secretary of State — UCC 20150455b Notice of State Tax Lien Lien Red With: ® Register of Deeds [] County Clerk PLEASE DO NOT WRITE MINIS SPACE Federal ID Number Social Security Number XXX -XX -8923 ARIEL ACOSTA ALBI2AR 319 S WALNUT ST APT 318 GRAND ISLAND NE 68801 Revenue Aunt Title Revenue Supervisor rue NE Sac State John A 6410 - UCC ST Lien Type: . County Original 0Conrivaeon Q Correded • HALL No.1640 F. 2 9915757203 -2 Pgse RCOSTR RLBIZRR ARIEL Filed: 07/07/2015 11:59 AM Spouse's Social Security Number Taxpayer Name and Mailing Address menl of Revenue bee complied wish the laws of the Stale of Nebrasl a in determining the amotlrll shown to be due, y the amount due after demand. This Notice of Slate llkli Lien Is an effective lien and serves to continue the priority of rty of the taxpayer. 06/30/2015 (308)632 -1210 Dale Phone Number 06130/2015 Dale 4- 494 -1974 flay. 8- 2013 supersedes 4449 -1974 Rey. 2-2002 ,\A)