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Progarxam <br />Tau Period <br />Assessment <br />Tax <br />Pence <br />Interest <br />Costs <br />Total Due <br />individual <br />2011 <br />06/17/2014 <br />2,185.50 <br />663.24 <br />337.19 <br />3,205.93 <br />Individual <br />2014 <br />04/29/2015 <br />24.00 <br />1.20 <br />.61 <br />25.81 <br />Total <br />$3,231.74 <br />0 <br />Feb, 22. 2016 3:53FM NE Secretary of State — UCC No. 5190 5. 4 <br />201601067 <br />Nebraska Department of <br />REVENUE <br />Nebraska ID Number <br />36509892 <br />Lien Serial Number <br />11665752 <br />Data of lien <br />02/17/2016 <br />sign <br />here <br />Lien Type: <br />Business Name and Location Address <br />Notice of State Tax Lien <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 Ilen 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. This lien will expire and <br />becorrte unenforceable 10 years after the data of recording If no <br />continuation statement Is recorded on or prior to the expiration of <br />the previous Ilen or continuation statement. <br />Lien Filed With: <br />N Register of Deeds fl County Clerk <br />PLEASE DO NOT WHITE IN THIS SPACE <br />Federal ID Number <br />Social Security Number <br />XXX -XX -5058 <br />Continuation LICorrected <br />PLEASE RETURN TO: <br />NEBRASKA DEPT OF REVENUE <br />PO BOX 94609 <br />LINCOLN NE 68509 -4609 <br />CRISPIN C CIPRIAN <br />811 W JOHN ST <br />GRAND ISLAND NE 688014749 <br />E Sae of Si ale Jahn A e-1. - UCC 5TL <br />89 16768952 -4 P9s: 1 <br />CIPRIHN CRISPIN C <br />Filed; 02/22/2010 02:01 PM <br />Seamier' Social Security Number <br />County <br />HALL <br />Taxpayer Name and Mailing Address <br />1 car* that the Nebraska Dapanmenl 01 Revenue has complied with the laws of the Slate of Nebraska In determining Me amount shown to be due, <br />and that the 'mayor tree lazed to pay the mount due after demand. This Notice of Slate Tax Lien is en effective; Ben and serves to continue the priority of <br />the Stale. Mrterersl In the :' = ` of : r. <br />�t�r,,�a,gi a � Revenue Agent <br />Tide <br />L � A/ilig r Revenue Supervisor <br />Authorized Z a Title <br />02117/2016 (308)632 -1206 <br />Dale Phone Number <br />02/17/2016 <br />Dam <br />4404.1971 rim 92013 Supereedee 4-949 -1974 Rev. 2-2002 <br />