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Tax <br />Program <br />Tex Period <br />Date of <br />Assessment <br />Tax <br />Perrelty <br />Interest <br />Casts <br />Total Due <br />Individual <br />2008 <br />01/04/2013 <br />5,363.56 <br />268.18 <br />1,409.81 <br />7,041.55 <br />Total <br />$7,041.55 <br />(0 <br />2015 2:52FM NE <br />Nobraako Dopertrnerp 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 lien.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 />Nebraska ID Number <br />23251530 - <br />Lien Serial Number <br />11555330 <br />Dale of Lien <br />07/27/2015 <br />sign <br />here <br />Authorized S <br />Lien Filed With: <br />® Register of Deeds D County Clerk <br />Uen type: <br />® Original <br />Business Name and Location Address <br />e .t State — UCC <br />20150516 7 <br />Notice of State Tax Lien <br />J Continuation 0 Corrected <br />Revenue Agent <br />Title <br />9915758874 -0 <br />PETERSON DANA J <br />Filed: 07/30/2015 <br />PLEASE DO NOT WHITE IN THIS SPACE <br />PLEASE RETURN TO: <br />NEBRASKA DEPT OF REVENUE <br />PO BOX 94609 <br />LINCOLN NE 68509 -4609 <br />Federal ID Number <br />Social Security Number <br />XXX- X70029 <br />DANA J PETERSON <br />PAMELA L PETERSON <br />4728 DEVA DR <br />GRAND ISLAND NE 68801 <br />Taxpayer Name and Mailing Address <br />07/27/2015 <br />Title Dale <br />Revenue Supervisor <br />2036 <br />A Gal. - <br />UCC ST <br />11:39 RM <br />I certify that the Nebraska Department of Revenue has complied With the taws of the Slate of Nebraska in determining the amourd sham to be due. <br />and that the texpaye has fated to pay the amount due after demand. This Notice of Stale Tax Lien is an effective lien and serves to continue the priority of <br />the Slate's interest In t q a -,° r I I ro ��, , the <br />j. °c as <br />F <br />P9s: 1 <br />Spouse's Social Security Number - - - - • -- - - - -- — • • <br />XXX -XX -7392 <br />County <br />HALL <br />(308)632 -1206 <br />Phone Number <br />07/27/2015 <br />Pate <br />4 -094-1974 Rev. 9 -2013 Suye!reede3 4449.1974 Rcv.212002 <br />