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Program Tex Period Assessment Tax Penalty Interest Costs Total Due Individual 2013 05/20/2014 69.23 13.40 6.80 89.43 Individual 2014 05/15/2015 609.00 30.45 8.06 647.51 Total $736.94 .28. 2015 2:565M NE Secretary of State — UCC 2®506651. Nebraska Department of REVENUE 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 llen.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. Nebraska ID Number 96091770 uen Serial Number 11558293 Date of Lien 09/23/2015 sign here Notice of State Tax Lien Lien Filed With; IN Register of Deeds 0 County Clerk Uen type Q original Business Name and Location Address PLEASE DO NOT WRITE IN THIS SPACE Federal ID Number Social Security Number XXX XX.4498 0 Continuation ❑ Corrected p6 Sec of z !6141 ]oh.. A Ode - U« a�� 9915781476 -5 Pos: 1 SRNCHES JORGE RRCHOLECRS Flied: 09!2612015 01:20 PM PLEASE RETURN TO: NEBRASKA DEPT OF REVENUE PO BOX 94609 LINCOLN NE 68509 -4609 Spouse's Scrotal Security Number County HALL Taxpayer Name and Mailing Address JORGE ARCHOLECAS SANCHEZ 1403 W 3RD ST GRAND ISLAND NE 68802 No. 288,7 E. 2/3 I car* that the Nebraska Department of Revenue has complied with the laws of the Slate of Nebraska in determining the amount shown to be due, and that the taxpayer has failed to pay the amount due after demand. This Notice of State Tar( Lien is an effective ten and serves to continue the priority of the Slate's Interest in the affected property of the taxpayer. Revenue Agent Title Revenue Supervisor Title Date 09/23/2015 (308)632 -1203 Phone Number 09/23/2015 Dale 4.4844974 Rim 0 -2018 Supenieees 4.949.7974 hey, 24002 ,„)z)