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Tax Program Tax period Assessment Tax Penalty Interest Coate Total Due Individual 2012 10/31/2015 1,694.33 79.80 199.21 1,873.34 Total $1,873.34 Jun. 14. 2017 3:01PM NE Secretary of State — UCC Nebraska oep•rtmerit 01 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.This 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 30900417 Lien Serial Number 11789386 Date of Lien 06/12/2017 lhorized Signal Lien Filed With: 201703972 Notice of State Tax Lien Register of Deeds 0 County Clerk Federal ID Number Social Security Number XXX -XX -4799 Lienlype; ® Or nal ❑Continuation ❑Corrected Business Name and Location Address DANIEL L BECK 2114 W 2ND ST GRAND ISLAND NE 68801 Revenue Agent Title Revenue Supervisor Title NO Sec of 5tn4e John A 6.1a - UCC STL county HALL I, PLEASE DO NOT WRITE IN THIS SPACE 9917793555 -5 Pgs. BECK DRNIEL L Filed; 06/14/2017 11:39 RIR Spouse's Social Security Number Taxpayer Name and Mailing Address N';. 1053 E. 8/10 I certify that the Nebraska Department of Revenue has complied with the laws of the Slate of Nebraska in determining the amount shown to ee due, and Thal the taxpayer has failed to pay the amount due after demand. This Notice of Slate Tax Llen is an elective lien and serves to continue the priority of the Stale's interest In the affected property of the taxpayer. 06/12/2017 (402)471 -5712 Dale Phone Number 06/12/2017 Dale 4.094.1974 Rev. 8-2013 Supersedes 4-949 -1971 Rey. 2-2002