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Tax Program <br />Tax Period <br />Date of <br />ASStSSment <br />Tax <br />Penalty <br />Interest <br />Costs <br />Total Due <br />Sales <br />07/01/2015 - 09/30/2015 <br />07/01/2016 <br />503.51 <br />80.35 <br />27.30 <br />.00 <br />611.16 <br />Sales <br />01/01/20I6 - 03/31/2016 <br />07/01/2016 <br />374.07 <br />37.41 <br />8.55 <br />60.00 <br />480.03 <br />Sales <br />10/01/2015 - 12/31/2015 <br />07/01/2016 <br />503.89 <br />50.39 <br />15.28 <br />.00 <br />569.56 <br />Total <br />1,660.75 <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 />PLEASE DO NOT WRITE IN THIS SPACE <br />Nebraska ID Number <br />12140791 <br />Federal ID Number <br />474234347 <br />Lien Serial Number <br />11701433 <br />Lien Filed With: <br />Social security Number <br />XXX -XX -3791 <br />Spouse's Social Security Number <br />XXX -XX -7083 <br />lin Register of Deeds J County Clerk <br />Date of Lien <br />January 23, 2017 <br />Lien Type: <br />❑ Corrected <br />County <br />HALL <br />1 <br />KI Original 0 Continuation <br />64Y <br />Feb. 7. 2017 3:21 <br />Nebraska Department of <br />REVENUE <br />Business Name and Location Address <br />( certify that the Nebraska Department of Revenue hes compiled with the laws of the State of Nebraska in determining the amount shown to be due, <br />and that the taxpayer has failed to pay the = . unt due after demand. This Notice of Stare Tax Lien Is an effective lien and serves to continue The priority of <br />the S interest in the ellected pry --rtv rtihe taxpayer. <br />sign Revenue Agent — / 7 402 - 471 -6067 <br />here Preparer's Signatur / � M Title Date Phone Number <br />,1 1 y t 7 , , A Revenue Senior Agent 1 <br />AutN oriz9d Signature Title Date <br />a494.1874 Rev. 8-2013 Supefe.edes 4949 -1974 Rev. 2.2002 <br />F <br />201700886 <br />Notice of State Tax Lien <br />Nc. 3587 F. 2 <br />Ng gde of li.i/ J0 l n r'a ale - SIL <br />9917766688 -7 <br />ESCRMILLP taBRml - t N .1R <br />Filed: 02/07/2017 ©9:52 AM <br />Pg =: <br />Taxpayer Name and Mailing Add <br />ABRAHAM JR. & STELLA ESCAMILLA <br />427 ROUSH LANE <br />GRAND ISLAND NE 68801 <br />