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Tax Program Tax Period Date of Assessment Tax Penalty Interest Costs Total Due Sales 08/01/2046 42/28/2017 05/01/2017 253 -04 - - 150.00 - 7.64 - .00 410.68 Total 410.68 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 lien_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. PLEASE Do NOT WRITE IN THIS SPACE . Nebraska ID Number 11801654 Federal ID Number 464209680 Lien Serial Number 11789225 Lien Filed With: Social Security Number Y (X_Nx_3837 Spouse's Social Security Number FA Register 01 Deeds • County Clerk Date of Lien June 15, 2017 Lien Type: rig Original 0 Continuation County HALL I• Corrected Jun. 28. 2017 ,OSPfvi NE Secretary if State — UCC nl braelca Department of REVENUE 201704301 Notice of State Tax Lien N-.1236 F. 2 sign h ere Prep Business Name and Location Address th; rized Signature Taxpayer Name and Mailing Address APRIL HARDY 380 N BROADWELL AVE GRAND ISLAND NE 68803 I certify that the Nebraska Department of Revenue has complied wtlh the laws of the State of Nebraska in determining the amount shown to be due, and that the : xpayer has tailed to pay the due after demand -This Notice of State MX Lien is an effective lien and serves 10 continue the priority of the Sl_„ erest In the affected prop taxpayer. Revenue Agent 06/21/2017 402- 4714067 Title Date Phone Number Revenue Senior Agent ‘,...?6—/ Tale Dale 4-4 ea -191a Rev. 02013 supereeoes 4-949 -1974 Fev. 2 -2002 An-