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Tax <br />Program <br />Tax Period <br />Date of <br />Assessment <br />Tax <br />Penalty <br />Interest <br />Costs <br />Total Due <br />Individual <br />2009 <br />08/1712014 <br />174.72 <br />153.00 <br />150.60 <br />478.32 <br />Total <br />$478.32 <br />Mar, 31. 2017 2:23PM 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 Iien.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 />39324362 <br />Lien Serial Number <br />11786083 <br />Date of Lien <br />03/29/2017 <br />Lien Type' <br />® original <br />Notice of State Tax Lien <br />lien Fled Wllh: <br />® Register of Deeds 0 county Clerk <br />Corlinuatlon <br />PLEASE DO NOT WRITE IN THIS SPACE <br />federal ID Number <br />Social Security Number <br />XXX -XX -8947 <br />0 Corrected <br />sign <br />here <br />Business Name and Location Address <br />orized Signature <br />Tide <br />TERI L MEIER <br />20769 HANK LN <br />DIXON MO 65459 <br />NE sec of f4ele John A note - UGC alt <br />County <br />HALL <br />D917789579 -9 Fags <br />MEIER TERI L <br />FILAR: 59/31/2017 11:14 AM <br />Spouse's Social Security Number <br />Taxpayer Name and Nailfn • Address <br />20 12741 2 Q 1) <br />t certify that Nebraska Department of Revenue has complied with the laws of the SIade of Nebraska in determining the amount shown to be due, <br />that the tax y' : r has failed to pay the amount due after demand This Notice of Slate Tax Lien Is an effective lien and serves to continue the priority of <br />ate's inte In the aN: ed property of the taxpayer. <br />Revenue Agent 03/29/2017 (402)471 -5731 <br />Title Date. Phone NuMter <br />Revenue Supervisor 03129/2017 <br />Date <br />4.444 -1074 tier. 9 -2019 Superseeee 4-9494874 RN. 2-2002 <br />