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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 />01/01/2013 - 12/31/2013 <br />08/12/2014 <br />1,175.00 <br />235.00 <br />72.60 <br />_00 <br />1,482.60 <br />Sales <br />01/01/2014 - 12/31/2014 <br />08/11/2015 <br />1,470.00 <br />x <br />294.00 <br />46.88 <br />.00 <br />1,810.88 <br />Total <br />3,293.48 <br />This Notice of State Tax Lien is issued by the Nebraska <br />PLEASE on NoT WRITE IN THIS SPACE <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 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 lien or continuation statement. <br />Nebraska ID Number <br />Federal ID Number <br />627909 <br />470412547 <br />Lien Serial Number <br />Lien Filed With: <br />Social Security Number <br />Spouse's Social Security Number <br />11665282 <br />[i] Register of Deeds ❑ County clerk <br />OW of Lien <br />Lien type: <br />County <br />February 12, 2016 <br />® Original Continuation ❑ea-reeled <br />HALL <br />4, <br />Jun. 6. 2016 3:17PM NE Secretary of State — UCC No. 6805 F. 3'3 <br />Nebraska I]epart+nant Of <br />REVENUE <br />sign <br />here Prep <br />Business Name and Location Address <br />d Signatu <br />Author) <br />20160349g <br />Notice of State Tax Lien <br />I certify that the ntehrasha Department of Revenue has compiled with the laws of the State o1 Nebraska in determining the amount shown to be due. <br />and that the taxpayer has tatted to pay the amount due alier demand.7hls Notice of State Tax Lien is an effective lien and serves to continue the priority of <br />the slat interest in t an ed property of the taxpayer. <br />4:4 / t <br />Revenue Scnior Agent <br />Title <br />Revenue Senior Agent <br />Title <br />NE <br />ec of 54.ia ae6n fl Get o - UGC STL <br />J IIIUI <br />99167748772 Pue:'I <br />EAGLES AUXILIARY 378 <br />Filed; 06/0612011 10' 04 AM <br />Tax.a er Name and Mailing Address <br />EAGLES AUXILIARY 378 <br />631 S LOCUST ST <br />GRAND ISLAND NE 68801 <br />02/05/2016 402- 471 -5709 <br />Date Phone umt,e <br />Date <br />4.494 -197a Rey &2019 Supersedes 4-949 -1974 Pen. 7.2002 <br />