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Tax Program Tax Period Date of Assessment Tax Penalty Interest Costs Total Due Withholding 10/01/2013 - 12/31/2013 11/24/2014 188.59 84.15 13.60 .00 286.34 Total 286.34 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 are a 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 Hen or continuation statement. PLEASE DO NOT WRITE IN THIS SPACE Nebraska ID Number 11061243 Federal ID Number 452805367 tien Serial Number 11557835 Lien Filed With: Social Security Number Spouses Social Security Number i l Re of Deeds ❑ County Clerk Date or Lied August 20, 2015 Lien Type: © Original ❑ Contlnuauon ❑ Corrected County HALL = er.24. 2016 3:26f'M NE Secretary Nebraska Dap4rtmenr of REVENUE sign here Business Name and Location Address 4- Authorize. S gnalure S — UCC 2O15O6565 Notice of State Tax Lien Tilie Revenue Senior Agent Title No. 2039 F. 3/4 NE SeC of 54.te Sohn fi t IE - UCC STL 991576128 -8 Pgs FRPNCL ROOFING LLC Filed: 09f2412015 01:40 PM Taxpayer Name and Mailing Address FRANCL ROOFING LLC 2211 W DIVISION ST GRAND ISLAND NE 68803 I certify that the Nebraska Department of Revenue has complied with the laws of the State of Nebraska in determining the amount shown to be due. ana that the taxpayer has failed to pay the u 1 due after demend.This Notice of State Tax Lien is an effective lien and serves to continue the priority of the 01ate .9J est in the affected prop y of e taxpayer. Revenue Agent ,107.5 402 - 471 -6067 ale Phone Number Date 4 494 -1974 Rex. a - 2013 Stine re1oes 4 -049 -1974 Rev, 2-2002 (1.)