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Tex Program Thx Period Date of Assessment Ts* Penalty interest Costs Total Due Individual 2014 05/20/2015 461.00 73.05 9.81 493.86 Total $493.86 Jan. 5. 2016 3:3 PM ---- - NE Secretary of State — UCC Nebraska Department of REVENUE This Notice of State Tax Lien Is Issued by the Nebraska Department of Revenue for unpaid taxes administered by the Tax Commissioner. Taxes, Including penalties, interest, and costs, which are shown below, are due from the taxpayer and remain unpaid after demand. These taxes area lien for all property located in the county and rights to property owned by the taxpayer or acquired before the expiration of this Iien.Thls den will expire and become unenforceable 10 years after the date of recording if no continuation statement is recorded on or prior to the expiration of the previous lien or continuation statement. Nebraska ID Number 45633460 Lien Serial H mhber 11563008 Dale of Llen 12/30/2015 sign here Notice of State Tax Lien tin riled with: ® Register of Deeds 0 County Clerk Lien type: od Business Name and Location Address 20/600053 Title PLEASE DO NOT WRITE IN THIS SPACE Federal lb Number Soda/ Security Number XXX -XX -1870 ❑ Continuation ❑ corrected KAREN A MUSILEK 4216 LARIAT CT GRAND ISLAND NE 68803 Revenue Agent Tdle Revenue Supervisor NC eQe of S *.te Jehn R 9.1a - uct STL 9916766029 -5 pas: 1111SJLEK KAREN R Filed: 01/05/2016 09:46 AM Spouse% Sodal Security Number County HALL Taxpayer Neale and Melling Address No. 4390 F. 4 1 certify that the Nedaka Department of Revenue has complied with the Taws of the Slate al Nebraska in delarmininp the amount shown to be due, and that the taxpayer has tailed to pay the amount due after demand. This Nodoe of Slate Tax Lien is an effective lien and serves to contktue the priority of the Slate's Interest in Hedad property of the laxpayer. 12/30/2015 (402)4716043 Dale Phone Number 12/30/2015 Dale 4-494.7974 Rex. 9.2Q1 t Supersede 4949.104 Rex 2-ROtR