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Tax <br />Program <br />Tax Period <br />Date ot <br />Assessment <br />Tax <br />Penalty <br />Interest <br />Costs <br />Total Due <br />Individual <br />2011 <br />04/10/2015 <br />2,687.00 <br />706.50 <br />345.46 <br />3,738.96 <br />Individual <br />2313 <br />05113/2015 <br />3,138.00 <br />784.50. <br />151.66 <br />4,074.16 <br />Total <br />$7,813.12 <br />Nov.30. 2015 2:51FM NE Secretary o <br />Nebraska Crepartrnent of <br />REVENUE <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 atter dernand.These taxes are a Ilen 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 Ilen or continuation statement. <br />Nebraska ID Number <br />47752351 <br />Lint Seriel Number <br />11561631 <br />sign <br />here <br />P <br />Authorized Sign <br />Notice of State Tax Lien <br />Lien Fled With. <br />© Register of Doeds ❑ County Clerk <br />Dale of Lien Lien Type: <br />11/2412015 © Ori ❑ Continuation ❑ Correged <br />Business Name and Location Address <br />State UCC NE S.c ni �'�' J�/11 6 , t �' TL <br />201508133 <br />9915764625 -5 Pus: 1 <br />ROJRS'KRLA D <br />Filed: 11/30/2015 02:0s PM <br />PLEASE DO NOT WHITE IN THIS SPACE <br />Federal ID Number <br />Social Security Number <br />XXX-XX-4846 <br />KALA D ROJAS <br />1409 N WEBB ROAD <br />GRAND ISLAND NE 68803 <br />PLEASE RETURN TO: <br />NEBRASKA DEPT OF REVENUE <br />PO BOX 94609 <br />LINCOLN NE 68509 -4609 <br />Spouse's Social Security Number <br />XXX -XX -5451 <br />County <br />HALL <br />Taxpayer Name and Mailing Address <br />I certify that the Nebraska Department of Revenue has complied with the laws of the State of Nebraaka In determining Me amount shown 10 be due, <br />and that the taxpayer has tailed to pay the amount due after demand. This Nonce of State Tax Lien Is an effective Nen and serves to continue the priority of <br />the Slate's Interest in the aft property of the taxpayer, <br />Dale <br />1 <br />Revenue Agent 11/24/2015 <br />Title Date <br />Revenue Supervisor <br />Tido <br />(308)632 -1203 <br />Phone Number <br />11/24/2015 <br />4 -494 -1974 Rev. 8.2013 Supersedes 4949 -1p74 Rev. 24002 <br />