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Tax Program <br />Tax Period <br />Assessment <br />Tax <br />Penally <br />Interest <br />Costs <br />Total Due <br />Individual <br />2010 <br />10/07/2014 <br />247.00 <br />61.75 <br />42.68 <br />351.43 <br />Total <br />$351.43 <br />Dec. 1. 2015 3:05FM NE Secretary of State — UCC <br />Nebraska Depattment of <br />REVENUE <br />Lien Serial Number <br />11561880 <br />Dale of Lien <br />11/25/2015 <br />sign <br />her <br />Business Name and Location Address <br />Authorized Signature <br />E3 <br />Lien Type: <br />© Orl <br />201508. 4 <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 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 lien.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 />Nebraska ID Number <br />40790053 <br />lien Filed wilh; <br />Register of Deeds ❑ County Clerk <br />Federal ID Number <br />Socal Security Number <br />XXX -XX -1871 <br />County <br />❑ Continuation ❑ Corrected HALL <br />Title <br />JEFFREY W MULINIX <br />412W 7TH ST <br />GRAND ISLAND NE 68801 <br />rise <br />Revenue Supervisor <br />NE Sac of 54.4a iohn Q Gale - UCC ;T <br />III 1 L <br />9 11 <br />915764640 -7 P9:: 1 <br />MULINIX JEFFREY W <br />Filed 12/51/2015 08:44 RN <br />PLEASE DO NOT WRITE INT IS SPACE <br />Spouse's Social Security Number <br />Taxpayer Name and Melling Address <br />No. 3835 F. 2 <br />I certify that the Nebraska Department of Revenue has complied with the laws of the Stale of Nebraska in determining the amount shown to be due, <br />and Mal the taxpayer has lied to pay the amount due after demand. This Notice at Slate Tex Lien is an effective lien and serves to continua the priority of <br />the Sta rarest in I = flatted properly of the taxpayer. <br />r,7i "' '� AI Revenue Agent <br />4.= , sr <br />Date <br />1 - 4941971 Rev. 9.2013 $vpemsedee 1-919-1974 tiev.2 -2002 <br />11/25/2015 (402)471.6043 <br />Dale Phone Number <br />11/2512015 <br />