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Tax Program <br />Tax Period <br />Assoscmant <br />Tax <br />Penally <br />Interest <br />Costa <br />Total Due <br />Individual <br />2014 <br />11/0312015 <br />2,749.00 <br />137.45 <br />123,37 <br />3,009.82 <br />Total <br />$3,009.82 <br />Oct. 14. 2016 1:55PM NE „_ ::retary of State — UCC <br />201606831 <br />.q) <br />Nareake Department 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 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 />97141289 <br />Lien Serial Number <br />11678830 <br />Date of Lien <br />10/12/2016 <br />Llert Filed with: <br />Register of Deeds 0Count Clefts <br />Lien Type: <br />Original <br />Business Name and Location Address <br />sign <br />h ere Prepare <br />Signature <br />Au orated Signature <br />Notice of State Tax Lien <br />PLEASE DO NOT WRITE IN THIS SPACE <br />Federal ID Number <br />Social Security Number <br />XXX -XX -3304 <br />0Contnuation DCorrected <br />WILLIAM J GALLES <br />306 S SHADY BEND RD <br />GRAND ISLAND NE 68801 <br />Revenue Agent <br />Tele <br />Revenue Supervisor <br />Title <br />County <br />HALL <br />No. 8394 <br />Taxpayer Name and Mailing Address <br />I certify that the Nebraska Departmamt of Revenue bee compiled with the laws of the Slate of Nebraska in determining the amount shown to be due, <br />and That the taxpayer has tailed to r ay the amount due after demand. This Notice of Stale Tax Lien is an effective lien and serves to continue the priority of <br />the : ,: a Interest In the efie <br />i % -illy of <br />t /I <br />e on - �� aTt- <br />4 sir�ie °�^ I l l ll{ S, <br />Pgs: 1 <br />Spouse's Social Security Number <br />loll 2/2016 (402)471 -5789 <br />Dale Phone Number <br />10/12/2016 <br />Date <br />e49e.19741 Rev, 8-2013 Suteraeuee 4-04b -19u4 Roc zeotia <br />9918781235 -i 55 rim G g LLE S Wm 4 DA13 10 ' <br />Flied. <br />