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Tax Program <br />Tax Period <br />Date of <br />Assessment <br />Tax <br />Penalty <br />Interest <br />Costs <br />Total Due <br />Sales <br />10/01/2011 - 06/30/2012 <br />12/01/2012 <br />.00 <br />309.63 <br />7.14 <br />.00 <br />316.77 <br />Sales <br />07/01/2012 - 03/31/2013 <br />11/01/2013 <br />.00 <br />• 75.00 <br />16.28 <br />.00 <br />91.28 <br />Sales <br />04/01/2013 - 06/30/2013 <br />06/02/2014 <br />32.35 <br />.00 <br />3.19 <br />.00 <br />35.54 <br />Sales <br />10/01/2013 - 03/31/2014 <br />06/02/2014 <br />145,38 <br />50.00 <br />7.28 <br />.00 <br />202.66 <br />Sales <br />04/01/2014 - 03/31/2015 <br />09/06/2015 <br />900.00 <br />190.00 <br />25.10 <br />.00 <br />1,115.10 <br />Total <br />1,761.35 <br />Jan. 15. 2016 3:17PM NE Secretary of State — UCC <br />Nebreake Department 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 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 />Nebraska 10 Number <br />8980748 <br />Lien Serial Number <br />11595256 <br />oate of Lien <br />November 9, 2015 <br />Business <br />sign <br />here <br />Lien Filed With: <br />® Peolster of Deeds • <br />Uen 'type: • <br />© Original <br />Name and Location Address <br />201600251 <br />Notice of State Tax Lien <br />0 County Clerk <br />PLEASE DO NOT WRITE IN THIS SPACE <br />Federal I0 Number <br />743064223 <br />Social Security Number <br />XXX -XX -9724 <br />fl Continuation ❑ Corrected <br />Revenue Agent <br />Title <br />Revenue Senior Agent <br />Ti he <br />Nr Ste of state Joi, <br />9916766872 -2 <br />TRFIXLER DAVID L. <br />Filsd: 01/15/2016 <br />DAVID L. TRAXLER <br />2203 N. SHERMAN BLVD <br />GRAND ISLAND NE 68803 <br />No. 4622 F. 2 <br />A eels - UGC STL <br />f 1 <br />Pes: 1 <br />01:36 PM <br />Spouse's Social Security Number <br />County <br />HALL <br />Taxpayer Name and Mailing Address <br />I certify that the Nebraska Department of Revenue has compiled with the laws of the Slate of Nebraska in determlhng the amount shown to be due, • <br />and that the taxpayer has (ailed to p amount due after demand. This Notice of State Tex Lien is an affective lien and serveS 10 conlinue.the priority of <br />the S ;Merest in the affected . • pa y of the taxpayer. • <br />iii. / 0/G <br />• Dale <br />402 - 471. =6067 <br />Phone Num <br />4-494 -1974 Rex. O-20i3 Supersedes 4949.1974 Ftev. 2 -: <br />