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Tax <br />Program <br />Tax Period <br />Date oi <br />Assessment <br />Tax <br />Penalty <br />Interest <br />Costa <br />Total Due <br />individual <br />2012 <br />1011612015 <br />742.00 <br />204.01 <br />71.29 <br />1,017.30 <br />Individual <br />2013 <br />10/16/2015 <br />356.00 <br />89.00 <br />23.53 <br />468.53 <br />Individual <br />2014 <br />10/16/2015 <br />2,502.00 <br />632.61 <br />90.28 <br />3,224.89 <br />Total <br />$4,710.72 <br />Jun. 29. 2016 32FM NE Secretary of State — UCC Nc.7191 F. 2 <br />Nebraska 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 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 IP Number <br />19337051 <br />Lien Serial Number <br />11673555 <br />Pate of Lien <br />06/27/2016 <br />sign <br />here <br />iLS,L►ie, A <br />Preparers Signature <br />Authorized Signetu <br />201604033 <br />Notice of State Tax Lien <br />PLEASE DO NOT WRITE IN THIS SPACE <br />Lien Filed With: <br />® Register of Deeds D County Clerk <br />Social Security Number <br />XXX XX -4678 <br />Lien Type: <br />© Ori ❑Continuation [I Corrected <br />Business Name and Location Address <br />Taxpayer Name and Mailing Address <br />1 <br />Federal ID Number <br />ELWYNE L MYERS <br />3024 GOLDENROD DR <br />GRAND ISLAND NE 68801 <br />rig eT 5 4� 4u .1chn ft e•1u - 1/CC 5Yr <br />Sec <br />8916776038 -6 Poe: 1 <br />MY ELWYNE L <br />Ftlad: OS/29/2315 01:30 Pn <br />Spouse's Social Security Number <br />County <br />HALL <br />I certify that the Nebraska Department of Revenue has compiled with the laws of the State Nebraska in determlrting the amount shown to be due, <br />and that the taxpayer hat faked to pay the amount due after demand. This Notice of Stale Tax Lien is an effective flee and serves to continue the priority of <br />Itre Slate's Interest In the . 1.: • : d property of the taxpayer. <br />Revenue Agent 06/27/2016 (402)471 -6712 <br />Trite late Phone Number <br />Revenue Su ervisor 06127/2016 <br />Title <br />Dale <br />44061074 Had. 6-2019 Supersedes 6949.1974 Rev. 2-2002 <br />