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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 />07/01/2014 - 08/31/2014 <br />11/03/2014 <br />351.98 <br />50.00 <br />18.75 <br />.00 <br />420.73 <br />Sales <br />09/01/2014 - 12/31/2014 <br />03/02/20I5 <br />573.30 <br />100.00 <br />27.18 <br />.00 <br />700.48 <br />Sales <br />02/01/2015 - 02/28/2015 <br />04/01/2015 <br />.00 <br />25.00 <br />.10 <br />.00 <br />25.10 <br />Sales <br />03/01/2015 - 12/31/2015 <br />03/25/2016 <br />2,200.00 <br />470.00 <br />51.27 <br />.00 <br />2,721.27 <br />Total <br />3,867.58 <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 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 />PLEASE DO NOT WRITE IN THIS SPACE <br />. <br />Nebraska ID Number <br />9662170 <br />Federal ID Number <br />Lien Serial Number <br />11698362 <br />Lien Fried With: <br />Social Security Number <br />-XX -7629 <br />Spouse's Social Security Number <br />li Register of Deeds ❑ County Clerk <br />Dale of Lien <br />June 14, 2016 <br />Lien Type: <br />Corrected <br />County <br />HALL <br />Original • Continuation <br />Jun. 24. 2015 2:32FM NE Secretary of State — UCC <br />Nebraska Department el <br />REVENUE <br />Sign <br />here Prep <br />Business Name and Location Address <br />201603914 <br />Notice of State Tax Lien <br />Revenue Agent <br />Title <br />Revenue Senior Ascnt <br />Tate <br />NE S.c of 5t <br />III <br />ALBERTO LUNA REYNA <br />PO BOX 581 <br />GRAND ISLAND NE 68802 <br />71 Jl;st. <br />Taxpayer Name and Mailing Address <br />Authorized Signature <br />9916775917 —g PA <br />REYNA ALBERTO LUNA <br />Filed: 06124/2016 01!16 PM <br />2 rL <br />I certify that the Nebraska Department of Revenue has complied with Inc laws of the State of Nebraska In determIning the amount shown to be due, <br />and that the taxpayer has failed to pay the a 01 due atter demand. This Notice of State Tax Lien Is an effective lien and serves to continue the priority of <br />me Slate' eat in the affected propel taxpayer. <br />402 - 471 -6067 <br />Phone Number <br />Dale <br />4- 414.1974 Rev. 5 -2013 Sueersedee 4 Rev. 2 -2002 <br />