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Pr <br />Tax Period <br />ae aess of <br />Tat <br />penally <br />Interest <br />Coats <br />Total Due <br />Individual <br />2011 <br />01/16/2016 <br />2,864.00 <br />716.00 <br />417.67 <br />3,997.67 <br />Individual <br />2012 <br />01/16/2016 <br />30,562.21 <br />7,640.55 <br />3,104.79 <br />41,307.55 <br />Individual <br />2013 <br />01/16/2016 <br />28,578.50 <br />7,144.63 <br />2,045.91 <br />37,769.04 <br />Total <br />$83,074.26 <br />tip. 7. 2016 ' I;I3FM NE `..rotary of 'State — UCC <br />{ <br />Nebraska Depertment 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 Iien.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 />Nehraslos ID Number <br />36506796 <br />Lien Serial Number <br />11676857 <br />Date of Lien <br />09/02/2016 <br />Notice of State Tax Lien <br />Lien Flied Wi h, <br />Register of Deeds ] County Clerk <br />Lien Type: <br />Business Name and Location Address <br />20105853 <br />PLEASE 00 NOT WRITE IN THIS SPACE <br />Federal ID Number <br />Social Security Number <br />XXX- XX-0120 <br />Original Continuation UCorrected <br />DEBRA WARREN <br />2623 SUNNY BROOK PL <br />GRAND ISLAND NE 68801 <br />County <br />HALL <br />aG xes c1 Sl.iOK Jahn R Gale - UtC <br />s916779531 -5 Pus: <br />WARREN DEBRA <br />Filed: 09/07/2016 10,31 AM <br />0. 7925 F. 2 <br />Taxpayer Name and Mailing Address <br />Spouse's Social Security Number <br />I candy that the Nebraska Department of Revenue has complied with the laws Of the Stale of Nebraska In determining the amount shown to be due, <br />and that the taxpayer has taped to pay the amount due after dernand.T Is Notice of State Tex Lien is an effective lien and serves to continue the phonily of <br />the States Interest In Ina affected arty of the taxpayer. <br />sign , <br />isb . A '1C Revenue Agent <br />here <br />�p :y :• Signature <br />rized Signature <br />Title <br />09/02/2016 (402)471-5712 <br />Date Phone Number <br />Revenue Supervisor 09/0212016 <br />Title Date <br />4041971 new. 8 Supersedes 4449 -1974 Rev. 2+2002 <br />ITt. <br />