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Tax Program Tax Period Date of Assessment Tax Penalty Interest Costa Total Due Individual 2012 06/08/2015 366.00 18.30 30.36 414.66 Total $414.66 Jan. 21. 2016 3:23PM NE Secretary of State — UCC No. 4704 F. 2/7 61 1 Nebre to 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 are a 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 lien will expire and become unenforceable 10 years after the data of recording if no continuation statement is recorded on or prior to the expiration of the previous lien or continuation statement. Nebraska ID Number 96087544 Lien Serial Number 11664154 Date of Lien 01/19(2016 sign here Prep Lien Piled With ® Register of Deeds 0 County Clerk Uen Type: OtIglnat Business Name and Location Address rized Signature 20160039'7 Notice of State Tax Lien Tile PLEASE DO NOT WRITE IN THIS SPACE Federal I7 Number Social Security Number XXX XX -0496 0 ContInuallon f Corrected FELIPE A VASQUEZ FLORES 1021 W 11 STREET GRAND ISLAND NE 68801 try that the Nebraska Department of Revenue has complied with the laws of the State of Nebraska in tletemtIning the amour shown to be due, and that Me taxpayer has faked b pay the amount due alter demand. Thus Nottoe of State Tax Lien is an effective ken and serves to continue the priority of Me S Interest In the acted property of the taxpayer- Revenue Agent 01/19/2016 (402)471-6043 Title pate Phone Number Revenue Supervisor Na in of Slake John a G.1. - UCC ail. 1 na16767632 -3 ps>;. 1 VFISQUEZ FLORES FELIPE A Filed: 01/21/2016 09 :12 AM County HALL Taxpayer Name and Mailing Address Spouse's Social Secut Ty Number 01/19/2016 Dale 4•494.19)< Rev - 82019 Superoetl% 4048- WA Rev. 2-2(302