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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 />04/01/2014 - 06/30/2014 <br />03/03/2015 <br />586.47 <br />58.64 <br />16.92 <br />-00 <br />662.03 <br />Sales <br />07/01/2014 - 09/30/2014 <br />03/03/2015 <br />577.80 <br />57.78 <br />12.29 <br />.00 <br />647.87 <br />Sales <br />01/01/2014 - 03/31/2014 <br />03/24/2015 <br />680.00 <br />130.21 <br />24.71 <br />.00 <br />834.92 <br />Sales <br />10/01/2014 - 12/31/2014 <br />04/01/2015 <br />365,62 <br />.00 <br />5.01 <br />.00 <br />370.63 <br />Total <br />2,515.45 <br />Ju1.14. 201 2:45FM <br />o 6-1) <br />Neoreeke 000De009nt of <br />REVENUE <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.Thls Tien 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 />Nebraska ID Number <br />• 9000593 <br />Lien Serial Number <br />11593394 <br />Dale of Lien <br />July 6, 2015 <br />sign <br />here <br />Authorized Signature <br />IJen Flied With: <br />® Register of Deeds El County Clerk <br />Lien Type: <br />cg Ori <br />Business Name and Location Address <br />Prepargf's Signature <br />(d ) _r <br />NE 'Secretary of State - UCC No. 1781 <br />Notice of State Tax Lien <br />Continuation <br />201504779 <br />PLEA$E DO NOT WRITE IN THIS SPACE <br />Federal D Number <br />Social Security Number <br />xx xx-5078 <br />County <br />Corrected HALL <br />I comity Ihat the Nebraska Department of Revenue has complied with the laws or Ma. Stale 01 Nebraska In determining the amount shown to be due, <br />and that the taxpayer has tailed to pay l ounl due after demand. This Notice Or State Tax Lien is an etfecklve lien and serves to continue the priority of <br />the Sla terest in the affected p .y .I the taxpayer, <br />Revenue Al;ent <br />Tax •a er Name and Mailing Address <br />JON I OSTERMEIER <br />604 £ YUND <br />GRAND ISLAND NE 68801 <br />Tine Date <br />Revenue Senior Agent <br />Tate <br />NE S of s4aka Jobn 0 al - uC STL 1111 <br />9915757759-9 Pgs: 1 <br />OSTERMEIER JON J <br />Filed: 07/14/2015 01:50 PM <br />Spouse's Sooial Security Number <br />402 -471 -6067 <br />Phone Number <br />7 — /S <br />Date <br />4 - 4944974 Rev. a -2013 Sueersedee 4.e49 -1971 Rev. 2 -2002 <br />Ivy(' <br />