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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 />Sales <br />01/01/2014 = 12/31/2014 <br />07/08/2016 <br />2,510.84 <br />502,171 79 <br />.0 0 <br />3,092.47 <br />Total <br />3,092 <br />This "Notice of State . Tax Lien is . issued by the Nebraska _ , <br />Department of Revenue for unpaid taxes administered by the Tax'' <br />Conirnissioner. Taxes, including penalties;" interest, and costs, <br />which are shown below; are due .from the taxpayer and remain <br />unpaid after demand.ThesetaXes area 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 unentorceab[e 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 />no NoT WRITE:IN THIS SPACE <br />. <br />Nebraska. 10 Number . '; <br />11425601 <br />Federal ID Number " <br />454014985 ., .. <br />Lien $erlal Number <br />11699475 ' <br />Lien Filed With: <br />] Register of needs ❑ County Clerk <br />Social Security Number <br />XXXAX -0417 <br />Spouse'S Social SeCurlt■ Number <br />Date of Liao . <br />September 8, 2016 <br />Lien Type:.'. <br />KI Original ❑ Continuation D Corrected <br />County <br />HALL <br />S .16. 2016 2:36PM <br />Nebraska DBpartriont • <br />REVENUE <br />Business Name and Location Address <br />01606121 <br />Notice of State Tax Lien <br />JACQUELINE E. BOWEN <br />1705 GRETCHEN AVE <br />GRAND ISLAND NE 68803 <br />No. 3275 P. 2 <br />• NE Sr a of yiate John R Gale •'lJC TL' • <br />1 5816779922 -4, Pe2 ; 1 <br />BOWEN JACQUELINE E. <br />Filed: 0911612016 09.40 AM <br />Taxpayer Name and Mailing Address <br />sign <br />here <br />1.certlty that the Nebreaka.Depart <br />and abet c rr paYar'haa felled 1 `• e <br />the S y ere§t In the aft= <br />Pre ' r's Signa? re <br />Authorizes Signature <br />J4 0 <br />hi 01 Revenue nas complied with the taws of the Stela of Nebraska in determining the.amounl shown io.be due,.'. <br />1 amount due alter demand. Tnls No110e of State Tax Lien ja•an effeoth!e Iie i grid serves to oontrn(e the priority. Qt <br />ty of the taxpayer. <br />Revenue Arent <br />Tttie . .: <br />Revenue. Senior Agent <br />TI11e <br />0911212016:•' <br />Date <br />402-471-6067 • <br />Phone Number <br />g- f3 <br />4.4 -1974 Rev. 872013 Supehead9e 4-849 -1974 Rev- 2 -2002 <br />