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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 />01/01/2014 - 12/31/2014 <br />08/11/2015 <br />1,240.00 <br />248,00 <br />27.01 <br />.00 <br />1,515.01 <br />Total <br />1,515.01 <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 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 />PLEASE 00 NOT WRITE IN THIS SPACE <br />Nebraska ID Number <br />11664134 <br />Federal 10 Number <br />463892155 <br />Lien Serial Number <br />11594904 <br />Lien Filed With; <br />® Register of Deeds [J County Clerk <br />Social Security Number <br />XXX_XX -8885 <br />Spou e's Social Security Number <br />Date al Lien <br />October 21, 2015 <br />Lien Type: <br />County <br />HALL <br />X original 0continuation <br />• Corrected <br />Nov. 2. 21:115 2:46FM NE Secretary of State — UCC <br />NebrBBka Oeparrhlenr Of <br />REVENUE <br />Business Name and Location Address <br />201507505 <br />Notice of State Tax Lien <br />CRAIG x1IvfMONS <br />1201 ALLEN DRIVE 174 <br />GRAND ISLAND NE 68803 <br />N�. 3423 P. 2 <br />NE Era of S4ale John n a.I5 - uu ht <br />9915763255 -9 Pas 1 <br />T119N0NS DRnIG <br />Filed: 11/02/2015 01:21 PP1 <br />Taxpayer Name and Mailing Address <br />I certify that the Nebraska Doparlmonl of Revenue has compiled with the laws of the State of Nebraska In determining the amount shown to be due. <br />and that the : payer has tailed to pay the amount due after 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 ny of the taxpayer. <br />Revenue Agent 10/26/2015 402 - 471 -6067 <br />Title Date Phone Number <br />4 /(a Revenue Senior Agent 10 - .2 9_ / 5 <br />Authorized Signature Tllle Dale <br />4494 - 1974 Play. B -2013 Supersedes 4,949.1574 Rev, 2.2002 /t <br />