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ProB am <br />Tau Pariad <br />Date Aunt <br />Tax <br />Penalty <br />Interest <br />Costs <br />Total Due <br />Individual <br />2009 <br />08/10/2016 <br />740.00 <br />185.00 <br />187.31 <br />1,112.31 <br />Individual <br />2010 <br />08/10/2016 <br />1,665.00 <br />416.25 <br />338.20 <br />2,419.45 <br />Individual <br />2011 <br />08/10/2016 <br />18,808.75 <br />4,702.19 <br />2,877.48 <br />26,388.42 <br />Individual <br />2012 <br />08/1012016 <br />46,264.04 <br />11,889.22 <br />4,922.00 <br />62,075.28 <br />Total <br />$91,995.44 <br />Nov. 3i, 2016 2:56PM NE Secretary of State — UCC <br />Nebraska D4partmant 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, end costs, <br />which are shown below, are due from the taxpayer and remain <br />unpaid after demand.These taxes are a Ilen 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.Thls 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 ti Number <br />47900709 <br />Lien Serial Number <br />11681305 <br />Date of Lien <br />11/28/2016 <br />sign <br />here <br />Business Name and Location Address <br />rs Signature <br />rized Signature <br />lien Hied Wirt: <br />® Register of Deeds ❑ courg Clerk <br />20i608022 <br />Notice of State Tax Lien <br />Title <br />PLEASE DO NOT WRITE INTHIS SPACE <br />Federal ID Number <br />Social security Number <br />XXX - XX - 7121 <br />Use iVpc <br />® Oa U continuation ['Corrected <br />JUAN C CHACON <br />222 RHODE ISLAND AVE <br />HASTINGS NE 68901 <br />Revenue Agent <br />No. 8920 P. 2 <br />r11 Sae ar S.1.4q Jahn A Gala - U[[ $TL <br />11 11111 1 <br />9916783329 -2 Psa: 1 <br />ri 111301201a 11:03 AM <br />Spouse's Social Security Number <br />County <br />HALL <br />Taxpayer Name and Melling Address <br />I se* that the Nebraska Department of Revenue hes complied with the laws of the State of Nebraska In determining the amount shown to be due, <br />and that rte taxpayer has fated pay the amount due after demand, Tftls Notloe of State Tax Llen is an effective lien and serves to continue the priority 01 <br />the Stale' Wears! M ate , property of the taxpayer <br />11/28/2016 (4021471-5789 <br />Tale Dale Phone Number <br />Revenue Supervisor 11/28/2016 <br />Dare <br />4.041071 Rev. 0.2118 Supersedes 4-e49 -1074 Hay. 2 -2002 <br />