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Tax Program Tax Period Date of Assessment Tax Penalty Interest Costs Total Due Withholding 04 /01/2014 - 06/30/2014 10/05/2015 245.00 85.75 11.27 .00 342.02 Withholding 07/01/2014 - 09/30/2014 10/05/2015 245.00 85.75 9.42 .00 340.17 Withholding 10/01/2014 - 12/31/2014 10/05/2015 245.00 85.75 7.57 .00 338.32 Withholding 01/01/2015 - 03/31/2015 10/05/2015 245.00 73.50 5.78 .00 324.28 Withholding 04/01/2015 - 06/30/2015 10/05/2015 245.00 49.50 3.92 .00 298,42 Withholding 07/01/2015 - 09/30/2015 11/10/2015 .00 10.73 .09 .00 10.82 Total 1,654.03 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 tien_This lien will expire and become unenforceable 10 years after the date of recording 0 no continuation statement is recorded on or prior to the expiration of the previous Ilen or continuation statement. PLEASE DO NOT WRITE IN THIS SPACE - Nebraska ID Number 8960216 Federal ID Number 200787306 Lien Serial Number 11696634 Lien t=1Ie0 with: Social Security Number Spouse's Social Security Number r,q Register of Deeds 0 County Clerk Data of Lien February 11, 2016 Lien Type: County HALL y1 Original 0 Comtnuation ■ Corrected Feb. 22. 2016 J.JJFM NE Secretary 0 State — UCC NebrsBtw ()apartment of REVENUE sign here Business Name and Location Address Notice of State Tax Lien rl 1 ,1 1 Leo of Staid' John P Ghia - UCC 57L l l 0916768.051 -2 Pas: 1 RY BARTELS Filed: 02122/2010 02:01�PM NE N. 5190 F 2014 4) i0G Taxpayer Name and Mailing Address RYAN BARTELS CONSTRUCTION CO. L.L.C. P.O. BOX 1526 GRAND ISLAND NE 68802 I certify alai the Nebraska Department of Revenue has complied with the laws of Me Slate of Nebraska In determining the amount shown to be due, and that the taxpayer has tailed 10 pay the amount due alter demand. Tbis Notice of State Tax Lien is an effective Ilen and aervea to continue the priority of the Skit rest in the affected pro he taxpayer, I1 _,, - ..� Revenue Agent Preps s Signature Tills Revenue Senior Agent horixed Signature T)lIe 02/16/2016 402- 471 -6067 Dale Phone Number Date 4.4$4.10Y4 Rev, 84012 Supersedes 4- 649 -1974 Rem 2 -2002