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ProTgerxem <br />Tax Period <br />Assessment <br />Tax <br />Penalty <br />Interest <br />Costs <br />Total Due <br />Individual <br />2012 <br />11/01/2013 <br />905.00 <br />45.25 <br />75.85 <br />1,029.10 <br />Individual <br />2013 <br />05/20/2014 <br />186.00 <br />9.30 <br />10.62 <br />205.92 <br />Individual <br />2014 <br />10/30/2015 <br />571.00 <br />37.66 <br />15.49 <br />624.04 <br />Total <br />$1,569.06 <br />Mar. 16. 2016 3.04PM NE Secretary of State — UCC No.5586 F. 3 <br />Nebre;k4 Department or <br />REVENUE <br />This Notice of State Tax Llen 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 alter 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 lien. 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 Ilen or continuation statement. <br />Nebraska ID Number <br />30102774 <br />Lien Serial Number <br />11666858 <br />Date of Lien <br />03/10/2016 <br />sign <br />here <br />Lion Filed WIU1: <br />Register of Deeds 0 County Clerk <br />Lien 1.pe: <br />Original 0 Continuation D Corroded <br />Business Name and Location Address <br />Authorized SIgr <br />201601565 <br />Notice of State Tax Lien <br />Federal ID Number <br />Social Security Number <br />XXX -XX -6717 <br />TODD W FRIESEN <br />224E 21ST ST <br />GRAND ISLAND NE 68801 <br />Revenue Agent <br />PLEASE 00 NOT WRITE IN THIS SPACE <br />Title <br />Revenue Supervisor <br />The <br />PLEASE RETURN TO: <br />NEBRASKA DEPT OF REVENUE <br />PO BOX 94609 <br />LINCOLN NE 68509 -4609 <br />NE Sae of S4Aie Jahn A Gala - UCC ETL <br />11 OH <br />9916770247 -3 Pgs! 1 <br />FRIESEN TODD W <br />Filed: 03116/2015 10:41 RI <br />Spouse's Socal SeCurlty Number <br />county <br />HALL • <br />Taxpayer Name and Mailing Address <br />I ceNly that the Nebraska Department at Reeenue has compiled with the laws of the Stale of Nebraska In determining the amount shown to be due, <br />and that 00 taxpayer a to amount ale after derttand. This Nonce of Slate Tax Lien is en effective In and eetves to oontlnue the priority of <br />the State's interest In • : V pr • :: of <br />03/10/2016 (308)632 -1206 <br />Date Phone Wilber <br />03/10/2016 <br />Date <br />4-4041074 Rat 62013 Supersedes 4901974 Rev, 2.2002 <br />