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Feb, 1. 2017 3:16PM NE Secretary of State — UCC <br />Nebraska 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.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 ID Number <br />9572953 <br />Lien Serial Number <br />11701383 <br />Dote of Lien <br />January 16, 2017 <br />Lien Filed With: <br />▪ Register of Deeds ❑ county clerk <br />Lien Type: <br />▪ Original <br />Business Name and Location Address <br />sign <br />h ere repay is Si <br />• thorixed Signature <br />20170073g <br />Notice of State Tax Lien <br />Continuation <br />PLEASE DO NOT WRITE IN THIS SPACE <br />Federal ID Number <br />480844616 <br />Social Security Number <br />XXX -XX -8212 <br />Corrected <br />Revenue Agent <br />Title <br />Revenue Senior Agent <br />77 Title <br />NE <br />County <br />HALL <br />Taxpayer Name and Mailing Address <br />EDWARD D. SABATKA <br />1523 S LINCOLN AVE <br />GRAND ISLAND NE 68801 <br />No. 9494 P 2 <br />See of State Bann n bale - u•.. art. <br />9917788228 -9 Res: <br />SABATKA EDWARD D. <br />Filed: 02/01/2017 09:63 AA <br />Spouses Socal Security Number <br />-.PO /7 <br />Date <br />Tax Program <br />Withholding <br />Withholding <br />Withholding <br />Withholding <br />309.87 <br />875.80 <br />Withholding <br />Tax Period <br />10/01/2013 - 12/31/2013 <br />04/01/2016 - 06/30/2016 <br />07/01/2016 - 09/30/2016 <br />01/01/2015 - 03/31/2015 <br />01/01/2015 - 03/31/2015 <br />Date of <br />Assessment <br />02/11/2014 <br />08/10/2016 <br />44.25 <br />.00 <br />11/10/2016 <br />12/09/2016 <br />12/16/2016 <br />Tax <br />885.08 <br />.00 <br />.00 <br />Penalty <br />49.14 <br />43.79 <br />.00 <br />Interest <br />37.11 <br />12.16 <br />5.60 <br />.00 <br />.00 <br />Costs Total Due <br />456.12 <br />931.75 <br />20.00 <br />20.00 <br />Total <br />60.00 <br />.00 <br />.00 <br />934.93 <br />20.00 <br />20.00 <br />2,362.80 <br />I terrify that the Nebraska Department of Revenue has complied with the laws of the State of Nebraska in determIning the amount shown to be due. <br />and that in r has failed to pay r me nt due alter demand. This Notice of State Tax Lien Is art effective Hen and serves to continue the priority of <br />the Si - • rest in the affected p • rty of the taxmen. <br />402 -471 -6067 <br />Phone Number <br />-3 ° - /7 <br />Dale <br />4- 494.19141 Rev. 8-2013 9upeisedes 4- 949 -1974 Ray. 2 - 2002 <br />