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Progrxam <br />Tax Period <br />Assessment <br />Tax <br />Penalty <br />Interest <br />Costs <br />Toter Due <br />Individual <br />2012 <br />06/30/2015 <br />233.00 <br />58.25 <br />18.51 <br />309.78 <br />Total <br />$309.76 <br />Dec. 14. 2015 3:20FM <br />• Nebraska Department of <br />This Notice of State Tax Llen 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 />REVENUE <br />Nebraska ID Number <br />41898354 <br />Lien Serial Number <br />11562631 <br />Date of Tien <br />12108/2015 <br />sign <br />here <br />Authorizes 9iinalure <br />NE Secretary o f State — UCC • No. 4076 F. 2 <br />Notice of State Tax Lien <br />Lien Fried With: <br />® Register of Deeds ❑ County Cierk <br />Lien Type: <br />Original <br />Business Name and Location Address <br />201508433 <br />Federal 0 Number <br />Social Security Number <br />XXX -XX -6133 <br />❑Continuation ❑COrrectad <br />TUT PUOL <br />419 E PHOENIX <br />GRAND ISLAND NE 68801 <br />• Revenue Agent <br />Title • <br />Revenue Sup ervisor <br />role <br />NH sec of slant John A S.ie - UCC ST <br />9915765203 -2 Ass <br />PUOL TUT <br />Filed: 12/1412015 02 ;03 PM <br />County <br />HALL <br />PLEASE DO NOT WRITE IN THIS SPACE <br />PLEASE RETURN TO: <br />NEBRASKA DEPT OF REVENUE <br />PO 80X 94609 <br />LINCOLN NE 68509 -4609 <br />Spouse's Social Security Number <br />Taxpayer Name and Mailing Address <br />I certify that the Nebraska Department of Revenue has complied with the laws of the Stale of Nebraska in Margining the amount drown to be due, <br />and Nral the taxpayer has failed to pay the amounl due alter demand, Thls Notice of State Tax Lien Is an eflecuve Nen and serves to continue the prl0rity of <br />the State's interest in the affe - ^ property of the taxpayer. <br />12108/2015 (308)632-1203 <br />Dete Phone Number <br />12/08/2015 <br />Dale <br />4 4114.107 4 Rev. 6-2019 Supersedes 4- 649.1974 far. 2 -2002 <br />