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Tax Program <br />Tax Period <br />Date of <br />Assessment <br />Tax <br />Penalty <br />Interest <br />Costs <br />Total Due <br />Sales <br />01/01/2013 - 12/31/2013 <br />08/12/2014 <br />580.00 <br />116.00 <br />30 -14 <br />.00 <br />726.14 <br />Total <br />726,14 <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 lien.This lien will expire and <br />become unenforceable in 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 />PLEASE DO NOT WRITE IN THIS SPACE <br />• <br />I <br />Nebraska ID Number <br />11579706 <br />Federal ID Number <br />Lien Serial Number <br />11594823 <br />Lien Filed Wilh, <br />Social Security Number <br />3000(X-6588 <br />Spouse's Social Security Number <br />C'7 Register of Deeds • County Cleric <br />Dale of Lien <br />October 15, 2015 <br />Lien Type: <br />County <br />R.AU L • <br />-t <br />® Original • Conlinualion <br />■ Corrected <br />Oct. 28. 2015 2:50FV1 NE ..,.rotary of State — UCC <br />Nebraska Department of <br />REVENUE <br />he re Prep r (0 Signature <br />Business Name and Location Address <br />4 -tat <br />uthofited Signature <br />Notice of State Tax Lien <br />20150'7407 <br />. Title <br />N 332 F. 2 <br />I E Lac of 4iaie John 11 Gale - UCC 4rL <br />8913783 045 -4 Psis: 1 <br />DONNER JOEY A <br />Filed: 10/26/2015 01:29 PM <br />Taxpayer Name and Mailing Address <br />JOEY A DONNER <br />2003 NW 55TH ST <br />LINCOLN NE 68528 <br />1 certify Lhal the Nebraska Department Of Revenue has compked with the laws al the Stale of Nebraska in determining the amount shown to be due, <br />and That .aye( has failed to pay t I due atter demand. This Notice of State Tax Lien is an effective lien and serves 10 continue the priority of <br />the St. - - , rest in the affected pr rty gif a taxpayer. <br />Revenue Agent 10/21/2015 402 -471 -6067 <br />Title Date Phone Number <br />Revenue Senior Agent . / 0^ 02-3-A <br />Date <br />4- a94.1924 Rev. 8.2013 Supersedes 4-940-1974 Rev. 2 - 2002 <br />