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P rogr am <br />Tax Period <br />Assessment <br />Tax <br />Penalty <br />Interest <br />Costs <br />Total Due <br />Individual <br />2010 <br />05/12/2015 <br />1,756.00 <br />439.00 <br />294.33 <br />2,489.33 <br />Individual <br />2011 <br />05/12/2015 <br />13.00 <br />3.25 <br />1.53 <br />17.78 <br />individual <br />2012 <br />05/19/2015 <br />63.00 <br />15.75 <br />4.61 <br />83.36 <br />Total <br />$2,590.47 <br />(p6 <br />P. 25. 201E 2:23FM NE S= cr -tary of State — UCC <br />Nebraate Department of <br />REVENUE <br />Nebraska ID Nuttier <br />36330981 <br />Lien Serial Number <br />11558197 <br />Dale of Den <br />09/23/2015 <br />Business Name and Location Address <br />2015400597 <br />Notice of State Tax Lien <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 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 />lien Red With: <br />IN Register of Deeds [] Courtly Clerk <br />PLEASE DO NOT WRITE IN THIS SPACE <br />Federal ID Number <br />Social Seeudry Number <br />XXX-XX-7247 <br />Lien Type: <br />® Original El Continuation [] Corrected <br />Taxpayer Name and Mailing Address <br />JEFFREY M REIS <br />4145 MANCHESTER ROAD <br />GRAND ISLAND NE 68803 <br />E Sac nl. <br />County <br />HALL <br />Nc. 2367 F. <br />Ile +e Jell-nn a AA le - <br />9915761371 - <br />RE S JEFFREY M <br />FL ed: 09/26/2015 09:48 Pr <br />Spouse's Social Security Number <br />I certify that the Nebraska Department of Revenue has Compiled Wilk the laws of the Stale or Nebraska in determining the amount shown to be due. <br />anti Graf rite taxparyer has fa o pay the amount due after demand. This Notce of State Tex Uen la an effective 0erl and serves to continue the pdodty of <br />the Stall Brest in the a + ' ad properly of the taxpayer. <br />Revenue Agent <br />Tine <br />Revenue Supervisor <br />Tine <br />2 <br />UCC ST <br />P9s; 1 <br />09/23/2015 (402)471 -6043 <br />Dale Phone Number <br />09/23/2015 <br />Data <br />4494 - 1074 Rev. 8-2013 Suuersdm 4 49 -1974 Rev. 2 - 2002 <br />1 r • <br />