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Tax Program <br />Tax Period <br />Date of <br />Assessment <br />Tax <br />Penalty <br />Interest <br />Costs <br />Total Due <br />Sales <br />01/01/2013 - 12/31/2013 <br />08/12/2014 <br />487.25 <br />199.00 <br />.00 <br />723.79 <br />Total <br />723.79 <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 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 IIen.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 Do NOT WRITE IN THIS SPACE <br />Nebraska 10 Number <br />Federal ID Number <br />11664134 <br />463892155 <br />Lien Serial Number <br />11593415 <br />Lien Filed With: <br />Social Security Number <br />-XX -8885 <br />Spouse's Soclal Security Number <br />F3 Register of Deeds • Counly CIeO <br />Dale of Lien <br />July 7, 2015 <br />lien Type; <br />IN Original DContinuation <br />County <br />HALL <br />I <br />li Corrected <br />°Lb. <br />Jul. 14. 2015 2,45FM NE Secretary cat State - UCC <br />Nebraska Deparrrnenr of <br />ENUE <br />sign <br />here <br />Business Name and Location Address <br />Prepa <br />2, 4'7 <br />Notice of State Tax Lien <br />No. 1 701 F. 1ti <br />NE Sr, of Skate John A cal. - NEC <br />991575775a -7 <br />T MMONS CRAIG <br />F led; 07/14/2015 01t50 PM <br />axpayer Name an M a lti ng A ddre <br />CRAIG TIMMONS <br />1201 ALLEN DRIVE 174 <br />GRAND ISLAND NE 68803 <br />ETL <br />Pas: 1 <br />1 certify that the Nebraska Depanment of Revenue has compiled with the laws of the Stale of Nebraska In determining the amount shown to be due, <br />and item t : xpayer has tared to pay 1 unt due after demand. Tilts Notice of State Tax Lien Is an effecttve Pen and serves to continue me priority of <br />the S lerest in the affected prune taxpayer. <br />Revenue Agent 07/09/2015 402- 471 -6067 <br />Title Date Phone Number <br />Revenue Senior Agent 1 - - / . <br />Authorize Signature Title Date <br />4- 494 -1974 ReV, 5 - 2013 Supersedes 4 -848 -1974 flee. 2 -2002 <br />Ott <br />