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Tax Program <br />Tax Period <br />Aae�etsgment <br />Tax <br />Penalty <br />Interest <br />Coats <br />Total Due <br />Individual <br />2011 <br />02/13/2015 <br />197.00 <br />9.85 <br />25.38 <br />232.23 <br />Individual <br />2013 <br />05/20/2014 <br />1,304.00 <br />65.20 <br />71.17 <br />1,440.37 <br />Total <br />$1,672.60 <br />Feb, 10. 2016 3:23FM fE S ecretary State — UCC <br />201600842 <br />Nebraska 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 Ilen.Thls 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 Number <br />40167283 <br />Lien Serial Number <br />11665355 <br />Date of Llen <br />02/08/2016 <br />Lien Filed With: <br />Re of Deeds DCounty perk <br />Lien type: <br />Original Continuation ° Corrected <br />Business Name and Location Address <br />orized Signature <br />Notice of State Tax Lien <br />PLEASE DO NOT WRITE IN THIS SPACE <br />Federal ID Number <br />Social Security Number <br />XXX -XX -6706 <br />Taxpayer Name and Mailing Address <br />JESUS F FLORES SERVIN <br />1627 SYLVAN STREET <br />GRAND ISLAND NE 68801 <br />Revenue Agent <br />The <br />Revenue Supervisor <br />Nor s .m of s +.t <br />County <br />HALL <br />No. 4995 F. 2/2 <br />Spouse's Social Security Number <br />I certify that the Nebraska Deparfinenl of Revenue has compiled with lire laws of the Slate of Nebraska in determinh j the amount shown to be due. <br />and Thal the taxpayer has : to pay the amount due after demand. This Nolte of Stale Tax Lien Is an effective Hen and serves to continue the priority of <br />the Sta merest' the ted property of the taxpayer. <br />sign <br />here Pre p ' <br />I ehn a Gale - UCC ITI. <br />9916768363 -5 Pea. <br />FLORES SERVIN JESUS F <br />Filed: 02/10/2016 52:35 PM <br />02/08/2016 (402)471 -6043 <br />Date Phone Number <br />02/08/2016 <br />Title Date <br />4.494 -1974 Hev. 5 supersedes 4846.1974 Rev, 2-2002 <br />