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Tax <br />Category <br />Tax Period <br />Date of <br />Amount of Tax <br />Penalty <br />Interest <br />Additlons <br />Balance of <br />Number <br />Assessment <br />Assessment Due <br />This Notice of State Tax Lien is Issued by the Nebraska Department of <br />Revenue for unpaid taxes pursuant to the revenue laws of the state of <br />Nebraska. Notice Is hereby given that taxes including penalties and <br />interest, which are shown below, are due from the taxpayer specified <br />below and remain unpaid after demand. These taxes constitute a Hen <br />in the county for real and personal property belonging to the taxpayer <br />or hereafter acquired. <br />Nebraska Identification Number <br />36004766 <br />Jul. 28. 2015 3 . Q4FV <br />Lien Serial Number <br />Date of-Lien <br />Business Name <br />Street Address <br />City <br />22 <br />22 <br />22 <br />22 <br />63260060 <br />04/05/2007 <br />BUSINESS NAME AND LOCATION ADDRESS <br />1999 <br />09/12/2006 <br />ccui '5o - 3s 3 <br />ygNyk NOTICE OF STATE TAX LIEN <br />Llen Filed With <br />Register of Deeds EICOunt Clerk <br />Lien Type <br />Original QContinuation QCorrected <br />State Zip Code <br />4,172.66 <br />Authorize • ig nature <br />Title <br />20150510 <br />Federal Identification Number <br />Name <br />Social Security Number <br />XXX -XX -5645 <br />TAXPAYER NAME AND MAILING ADDRESS <br />ROCKY L SMIDT <br />Street or Other Mailing Address <br />3035 N WEBB RD <br />City <br />GRAND ISLAND <br />Na• 2522 <br />N@ Sec of Sto *e John <br />ma, <br />9915758568 -5 <br />sMIDT ROCKY L <br />Fi1ed: 07125,2015 02;31 <br />F <br />PM! <br />PLEASE DO NOT WRITE IN THIS SPACE <br />PLEASE RETURN TO <br />NEBRASKA DEPT OF REVENUE <br />I PO BOX 94609 <br />LINCOLN NE 68509 -4609 <br />County <br />Hal <br />State <br />NE <br />UCC SCON <br />J <br />Spouse's Social Security Number <br />Zip Code <br />68803 <br />2000 <br />2001 <br />2002 <br />01/2312007 <br />06/20/2006 <br />06/20/2006 <br />7,717.38 <br />1,025.00 <br />364.00 <br />1,929.35 <br />256.25 <br />91.00 <br />3,203.45 <br />333.24 <br />88.70 <br />TOTAL <br />1,043.17 <br />2,107.59 <br />7,323.42 <br />12,850.18 <br />1,614.49 <br />543.70 <br />$ . 22,331.79 <br />.1 hereby certify that the Nebraska Department of Revenue has complied.with the revenue laws of the State of Nebraska In the determination of the <br />• amount shpwn to be due, and he taxpayer has failed to pay the amount due after demand. If this Notice of State Tax Lien is an extension of an <br />effective lien, it serves to continue the r levity me ms's - rest in the affected property of the taxpayer, <br />® Diane' icka + 4L� Uevenue A.ent 07/23/2015 <br />si gn . Prep: - s .na / �� i le . . Date . Revenue Supervisor <br />.here 8 <br />308 632 -1206 <br />Telephone Number <br />07/23/2015 <br />Date <br />4-454-1974 REM' : 2 -2002 Super,edee 4-1 -1974 Rev. 10.1995 <br />SEE ATTACHMENTS <br />