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Tax <br />Program <br />lax Period <br />Date of <br />Assessment <br />Tax <br />Penalty <br />Interest <br />Costs <br />Total Due <br />Individual <br />2012 <br />06105/2013 <br />851.00 <br />72.46. <br />72.10 <br />995.56 <br />Total <br />$995.56 <br />Dec. 28. 2515. 52FM NE Secretary of State — UCC 201508'76.8. 0..4295. F. 4 <br />' NE Sac of 5aa4e Jahn A <br />d.t. - a6C 511 <br />991$7857 -4 <br />111 <br />OLSEN GRYLENE R <br />Piled: 12/2B/2015 01:6 PM <br />Nebraska Department of <br />REVENUE <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 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 lien or continuation statement. <br />Nebraska ID N1mber <br />39316491 <br />Lien Serial Number <br />11562654 <br />Dale of Uen <br />12/22/2015 <br />lien Filed With: <br />IN Register of Deeds County Clerk <br />UM Type: <br />® Original D Conlinualon f Cor eded <br />Business Name and Location Address <br />sign <br />here <br />• I certify that the Nebraska Department of Revenue has complied with the laws of the State of Nebraska in determining the amount shown to be due. . <br />end that the taxpayer has tailed to pay the ...• 1# due after demand. This Notice of Stale Tax Llen is an effective lien and serves to continue the priority of <br />the Stare's Intereat in the a . _ .;y;� of the fa <br />Authorized Si'^' ire <br />Notice of State Tax Lien <br />Tkle • <br />PLEASE DO NOT WRITE IN THIS SPACE <br />Federal ID Number <br />Social Security Number <br />XXX -XX -6671 <br />PLEASE RETURN TO: <br />NEBRASKA DEPT OF REVENUE <br />PO BOX 94609 <br />LINCOLN NE 68509 -4609 <br />GAYLENE A OLSEN <br />2323 BELLWOOD DR TRAILER 107 <br />GRAND ISLAND NE 68801 <br />Spousea Social Security Number <br />County <br />HALL <br />Taxpayer Name and Mailing Address <br />Revenue Agent 12/22/2015 (308)632 -1206 <br />Title Date ' Phone Number <br />Revenue Supervisor 12/22/2015 <br />Dale <br />4 - 4941974 Rey. 2013,6upersedea 4849.1974 Rev.2.2002 <br />