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TaX Program <br />Tax Period <br />A* S e 3S nt <br />Tax <br />Penalty Interest Costs <br />79.70 <br />Total Due <br />E <br />Individual <br />2014 <br />10/30/2015 <br />1,594.00 <br />MI <br />. <br />Total <br />$1,724.93 <br />May. 13. 2016 12PM NE Secretary of State — UCC <br />N6branke 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 Ilan,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 />12007439 <br />Lion serial Number <br />11670539 <br />Dale of Lien <br />05110/2016- <br />Uen Flied With: <br />Register of Deeds J County Clerk <br />Lien Type: <br />Original DConlinuaton Dcorrected <br />Business Name and Location Address <br />sign <br />here <br />I oenify that the Nebraska Department of tievenue has complied with the laws of the Stale of Nebraska in determining the amount shown to be due, <br />and that the taxpayer has failed to pay the amount due alter demand. This Nolio9 ol State Tax Lien is an effective Ilen and serves to continue Ine priority of • <br />the Slates Interest In l ift to ,. - ., of payer. <br />.R Niii.w r,.rr0 <br />v <br />Authorized <br />Notice of State Tax Lien <br />PLEASE DO NOT WHITE IN THIS SPACE <br />Federal ID Nunbor <br />Social Sacurity Number <br />XXX -XX -9068 <br />PLEASERETURN TO: <br />NEBRASKA DEPT OF REVENUE <br />PO BOX 94609 <br />LINCOLN NE 68509-4609 <br />Taxpayer Name and Mailing Address <br />DENNIS NELSON <br />501 N PINE ST <br />GRAND ISLAND NE 68803 <br />A Gale - ACC STL <br />99167737668 Pgs t 1 <br />NELSON DENNIS <br />Filod: 05113/2016 01:12 PM <br />E %u of L4- {r Jahn <br />2 6k4 6 Q 2 4P4 8 §4 <br />Spouse's Social Security Number <br />county <br />HALL <br />Revenue Agent 05110/2016 (308)632 -1206 <br />. Titre Date Phone Number <br />Revenue Supervisor 05/10/2016 <br />TIUe Date <br />4494 -19 Rev, Buts Supersedes 4449 -197 Rev, 2 -2002 <br />