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Tax <br />Program <br />Tax Period <br />Date of <br />Assessment <br />Tax <br />Penalty <br />Interest <br />Costa <br />Total Due <br />Individual <br />2010 <br />11/21/2015 <br />9,416.00 <br />2,354,00 <br />1,832.90 <br />13,602.90 <br />Individual <br />2011 <br />11/21/2015 <br />15,543.70 <br />4;232.05 <br />2,246.38 <br />22,022,13 <br />Individual <br />2012 <br />03/28/0016 <br />13,593.49 <br />3,737.45 <br />1,363.08 <br />18,694.02 <br />Total <br />$54,319.05 <br />Aug. 22. 2016 3:02PM NE Sec rotary of — UCC <br />Nebraska Deperrmenr of <br />REVENUE <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 II 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 />47157796 <br />Lien Serial Number <br />11675991 <br />Date of Lien <br />08/17/2016 <br />sign <br />here PrePar <br />201605431 <br />Federal ID Number <br />NE Sac of &Foie <br />PLEASE DO NOT WRITE IN THIS SPACE <br />PLEASE RETURN TO: <br />NEBRASKA DEPT OF REVENUE <br />PO BOX 94609 <br />LINCOLN NE 68509 -4609 <br />9916778812 -0 Pea. <br />RDR AN ARELLRNO ESTELLA F <br />Filed: 06!2212016 11:50 All <br />Lien Filed With: <br />Register 01 Deeds [J County Clerk <br />Lien Type: <br />Original <br />El Continuation <br />Social Security Number <br />XXX -XX -8643 <br />0 Corrected <br />Business Name and. Location Address <br />Taxpayer Name and Mailing Address <br />Spouse's Social Security Number <br />County <br />HALL <br />ESTELLA F ADRIAN ARELLANO <br />1109 W ANNA STREET <br />GRAND ISLAND NE 68801 <br />I certify that the Nebraska Departmem of Revenue has sampled with the laws of the State of Nebraska In delerminmg the amount shown to be due, <br />and that the taxpayer has felled to pay the amount due after demand. TINS Notice of State Tax Lien is an elective yen and serves to continue the priority of <br />Me Slate's interest in the : >yy; p e 0 taxpayer. <br />Revenue Agent <br />Title <br />Revenue Supervisor <br />Title <br />Authorized <br />N�.7795 P. 2 <br />Jahn a 0.la - UCC STL <br />ii <br />1308)632 -1206 <br />Phone Number <br />08/17/2016 <br />Date <br />4494.1974 Rev. 94013 Supersedes 4-949 -1 W4 Reu 2 -2002 <br />