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P rogr am <br />Tax Period <br />Date of <br />Assessment <br />Tax <br />Penalty <br />Interest <br />Costs <br />Total Due <br />Individual <br />2008 <br />01/06/2010 <br />20.00 <br />89.75 <br />46.01 <br />155.76 <br />Individual <br />2010 <br />08/29/2014 <br />1,369.00 <br />423.50 <br />277.66 <br />2,070.16 <br />Total <br />52,225.92 <br />Oct. 22. 2015 3:11PM1 NE Secretary of Stat — UCC <br />oa <br />Nebraska Department of <br />REVENUE <br />201507262 <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.This lien will explre 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 Tien or continuation statement. <br />Nebraska ID Number <br />97956716 <br />Lien Serial Number <br />11559611 <br />PLEASE 00 NOT WRITE INTIIIS SPACE <br />No.3254 P. 2/5 <br />Ne Sec of Simi. John R 6.1. - UCC STL <br />9915762687 -3 Pas; 1 <br />BERMUDEZ CARLOS <br />Flied: 10/22/2015 11:52 API <br />Data of lien <br />10/20/2015 <br />Sign <br />here <br />Uen Flied Wilk <br />® Register of Deeds El County Clerk <br />Lien Type: <br />© Ori <br />Business Name and Location Address <br />Continuation <br />Signs um <br />Auth$rized Signature <br />TN. <br />Federal ID Number <br />Social Security Number <br />XXX -XX -4796 <br />❑ Corrected <br />CARLOS BERMUDEZ <br />311 E 5TH STREET <br />GRAND ISLAND NE 68801 <br />Revenue Supervisor <br />Spouse's Social Security Number <br />County <br />HALL <br />Tax; er Name and Mallln. Address <br />I Certify that the Nebraska Department of Revenue has compiled with the laws of the Stale of Nebraska in determining the amount shown to be due, <br />and Mai = taxpayer has fail =.< 10 pay the amount due after demand. TMs Notice of Slate Tax Lien Is an effective lien and serves to continue the priority of <br />m S interest in ed properly of the t= .. ayer. <br />Reven Agent 10/20/2015 (402)471 -6043 <br />Title Date Phone NuuOar <br />10/20/2015 <br />Date <br />4 -464 -1674 Rev. 0.2013 Supeieedes 4- 949 -1974 Rev. 2 -8002 <br />