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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 />Withholding <br />01/01/2016 - 03/31/2016 <br />07/03/2016 <br />1,310.00 <br />196.50 <br />8.72 <br />.00 <br />1,515.22 <br />Withholding <br />10/01/2015 - 12/31/2015 <br />07/03/2016 <br />1,310.00 <br />393.00 <br />18.41 <br />.00 <br />1,721.41 <br />Total <br />3,236.63 <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 dernand.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 n0 NOT WRITE IN THIS SPACE <br />Nebraska ID Number <br />11704187 <br />Federal lD Number <br />900922598 <br />Lien Serial Number <br />11674366 <br />Lien Fled With: <br />Sodal Security Nuatier <br />Xx]f(_O_4812 <br />Spouse'a Social Security Number <br />pi Register of Deeds • County Clerk <br />_ <br />bate of Llen <br />July 20, 2016 <br />Lien Type: <br />D Corrected <br />County <br />HALL <br />/Y1 Original II Continuation <br />Aug. 12. 2016 1:59FM NE Secretary of State — UCC <br />Nebraska Department et <br />REVENUE <br />Business Name and Location Address <br />I certify that the Nebraska Department of Revenue has compiled with the Iawg el the Slate Of Nebraska in determining the amount shown to be due, <br />and that the taxpayer has felled to pay the amount due after demand, This Notice of State Tax Lien is an effective lien and serves to continue the priority of <br />the date's Inter In the affected property fur , aver. <br />Authorized Signature Title <br />Notice of State Tax Lien <br />Taxpayer Name and Mailing Address <br />NORMA SANCHEZ <br />1116 W OKLAHOMA AVENUE <br />GRAND ISLAND NE 68801 <br />2046€062F24 <br />NE S¢c of Si.ie Jahn A 01.12 - UCC STL <br />99167763 -1 <br />Pes: 1 <br />SANCHEZ NORMA <br />Filed: 00112,2018 11:28 AM <br />Revenue Senior Agent 07/13/2016 4021171 -5727 <br />Title Date Phone Number <br />Revenue Senior Agent r 40 (9 <br />Date <br />4.494.1974 New 8-2013 Supersedes 4-948 -1974 Flex, 2.2002 <br />