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ProgTaX <br />ram <br />Tax Period <br />Data of <br />Assessment <br />Tax <br />Penalty <br />Interest <br />Costs <br />Total Due <br />Individual <br />2014 <br />01/21/2016 <br />399.00 <br />19.95 <br />15.90 <br />434.85 <br />Total <br />$434.85 <br />Aug. 16. 2016 2:41FM NE Secretary of State — UCC <br />Nebraska Department of <br />REVENUE <br />Lien Serial Number <br />11675720 <br />Date of Lien <br />08/12/2016 <br />sign <br />her <br />orized Signature <br />Notice of State Tax Lien <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 ID Number <br />95779574 <br />Lien Flied With: <br />Register of Deeds [1 County Clerk <br />Lien Type: <br />® Onglnel <br />Business Name and Location Address <br />Federal ID Number <br />Social Security Number <br />XXX -XX -0397 <br />Continuation ❑ Corrected <br />LAZARO MBONAKIRA <br />616 E DIVISION ST APT 1 <br />GRAND ISLAND NE 68601 <br />partmerd of Revenue has complied with the laws of the Stale of Nebraska In determining the amount shown to be due, <br />pay the amount due idler demand. Thle Nohk a of State Tax Hen fs an effective lien and serves to continue the priority of <br />ted property of the taxpayer <br />Revenue Agent <br />PLEASE DO NOT WRITE IN THIS SPACE <br />Title <br />Revenue Supervisor <br />Title <br />County <br />HALL <br />NE Sae <br />Taxpa rimer Name and Mailing Address <br />g.0 05 49 <br />of a at. John A Oate - UCC iTL <br />9918778558 -8 P96: 1 <br />MBONAKIRA LAZARD <br />Filed: 09/18/2016 00:47 AM <br />Spouse's Social Security Number <br />08/12/2016 (402)471-6043 <br />Data Phone Number <br />08/12/2016 <br />Date <br />4 ftev, 8-2010 Supereedee 4- 940-1571 Ras. 2-2002 <br />