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Tax Program Tax Period Dale of Assessment Tax Penalty Interest Costs Total Due Individual 2013 07/16/2016 451.00 22.55 35.03 508.58 Total $508.58 Nov, 17. 2016 2:58PM NE Secretary of State — UCC No. 8797 P. 2/3 NeDreeka Department of REVENUE This Notice of State Tax Lien is issued by the Nebraska Department of Revenue for unpaid taxes administered by the Tax Commissioner. Taxes, including penalties, interest, and costs, which are shown below, are due from the taxpayer and remain unpaid after demand.These taxes are a lien for all property located in the county and rights to property owned by the taxpayer or acquired before the expiration of this iien.Thls lien will expire and become unenforceable 10 years after the date of recording if no continuation statement Is recorded on or prior to the expiration of the previous lien or continuation statement. Nebraska ID Number 96088141 Len Serial Number 11680785 Lien Filed With: Repfsler of Deeds ❑ County Clerk bate of Lien Len Type: 11/15/2016 ®ori ❑ continuation Business Name and Location Address sig here I cerllfy d That the elea Into A + R2ed Signature Nebraska has e aft arlrnent 201607720 Notice of State Tax Lien PLEASE GO NOT WRITE IN THIS SPACE Federal ID Number Social security Number XXX -XX -1423 as complied with the laws of the State of Nebraska In determining Me amount shown to be due, after demand. This Notice of state TIm Lien Is an efective lien and serves to continue the priority of payer. County El Corrected HALL Taxpayer Name and Mailing Address JOSE F SANCHEZ AVELARD 824 EAST 11TH ST GRAND ISLAND NE 68801 Revenue Agent Tide Revenue Supervisor Title NI Gee of 54a5e Jahn a Bate - UCt ST 1:1 11111 99i ®782841 -7 Pia: 1 SANCHEZ AVELARD JOSE F Filed: 11/17/201E 10:24 AM Spouse's Social Security Number 11/15/2016 (402)471 -5731 Date Phone Number 11115/2016 Dale 4.494 -1971 Het 8.2013 Supen.edee 4- 545.1974 net 2 -2002 1�