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Tax Program Tax Period Date of Assessment Tax Penalty Interest Costs Total Due Register of Deeds 0 County Clerk 07/01/2011 - 06/30/2014 08/16/2015 37.95 66.61 4.28 -00 108.84 05/01/2014 - 08/09/2014 08/16/2015 2,325.00 579.75 67.89 .00 2,972.64 03/01 /2013 - 06/30/2013 08/16/2015 .00 588.61 3.77 .00 592.38 10/01/2013 - 10/31/2013 08/16/2015 .00 111.78 .18 .00 111.96 Withholding 01/01/2014- 08/09/2014 09/16/2015 184.00 93.40 6.10 .00 283.50 Withholding 01/01/2013 - 12/31/2013 08/16/2015 .00 31,81 1.17 .00 32.98 Total 4,102.30 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 area lien for all property located in the county and rights to property owned by the taxpayer or acquired before the expiration of this IIen.ThIs 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. PLEASE DO NOT WRITE INTHIS SPACE . Nebraska ID Number 8239665 Federal ID Number 391964386 Lien Serial Number 11594068 Lien Piled With: Social Securhy Number XXX- XX-4498 SpouSe'e Social Security Number Register of Deeds 0 County Clerk Dale of Lien August 16, 2015 Lien Type: ❑ Corrected County HALL g Original 0 Continuation Sep. 9. 2015 3:26PM NE Secretary cf State — UCC No. 2557 F. 2/3 Nebraska Department or REVENUE ■ sign h ere Prepfrer's Sign ure Business Name and Location Address urhorized Signature - Title 215061'2 Notice of State Tax Lien 1 Ceniy that the Nebraska Department of Revenue has complied with the taws of the Slate of Nebraska in determining the amount Shown to be due. and Ihal the taxpayer has failed to pay th .urn due atier demand. This Notice of Slate Tax Lien Is an effective Tien and serves 10 continue the priority of the 3 Interest in the affected prop l the taxpayer. Revenue Agent Title Revenue Senior Agent NE enc of S {OIn John N ; IQ - UCC STL 891376042 - Pos: 1 WISEIIAN KIMBERLY P. Filed: 09/091201 09161 AM Taxpayer Name and Mailin KIMBERLY A. WISEMAN 103 BEACHWOOD DR GRAND ISLAND NE 68803 Address ? 402 - 471 -6067 Dale Phone Number �- i NsS Dale 4 Rau. 8.2013 Supersedes 1 - 919.1974 Rev. 2-205 \J