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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 />06/01/2014- 12/31/2014 <br />04/06 /2015 <br />2,834.19 <br />1,141.00 <br />209.32 <br />.00 <br />4,184.51 <br />Salts <br />07/01/2012 - 06/30/2015 <br />08/25/2015 <br />22,141.97 <br />2,415.00 <br />1,544.06 <br />200.00 <br />26,301.03 <br />Sales <br />07/01/2015 - 09/30/2015 <br />11/02/2015 <br />1,034.34 <br />141.16 <br />14.56 <br />.00 <br />1,190.06 <br />Sales <br />10/01/2015 - 10/31/2015 <br />12/28/2015 <br />.00 <br />45,68 <br />.00 <br />.00 <br />45.68 <br />Sales <br />11/01/2015 • 11/30/2015 <br />01/13/2016 <br />.00 <br />38.41 <br />.00 <br />100.00 <br />138.41 <br />Total <br />31,859.69 <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 />PLEASE DO NOT WRITE INTHIS SPACE <br />Nebraska ID Number <br />7009674 <br />Federal ID Number <br />470776255 <br />Lien Serial Number <br />11696557 <br />Olen Filed with: <br />Social Security Number <br />XXX-XX-9068 <br />Spouse's Social Security Number <br />i:0 Register of Deeds ■ County Clerk <br />Date of Lien <br />February 4, 2016 <br />Lien Type: <br />County <br />HALL <br />El Original II Continuaillon <br />• Corrected <br />Feb. 18. 2016 3:30 FM NE Secretary of State — UCC <br />201600987 <br />sign <br />here <br />Nebraska Department of <br />REVENUE <br />Business Name and Location Address <br />reo arer's Signature <br />Authorized Signature <br />Notice of State Tax Lien <br />NE See of St.t. John A Gale <br />DENNIS D. NELSON <br />501 N PINE ST <br />GRAND ISLAND NE 68801 <br />No. 5134 P. 2/3 <br />001678875a -5 <br />NELSON DENNIS O. <br />Flied, 02/10/2016 10:02 AM <br />Taxpayer Name and Mailing Address <br />UCC 5TL <br />Pea I <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 />and that the taxpayer has felled to pay the amount due after demand. Thia Notice of Stale Tax Lien is an effective Fen and serves to continue the priority of <br />the Slate Brest in the affected propert - Taxpayer. <br />Revenue Agent , gAup�oit0 /iv 402- 471 -6067 <br />Title Date Phone Number <br />Revenue Senior Agent a—/6- / f o <br />7atle Dale <br />44344 e74 Rev, a - 2013 $uperTedes 4-$49 914 Rev. 2.200 <br />