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Tax Program <br />Tax Period <br />Date of <br />Assessment <br />Tax <br />Penalty <br />Interest <br />Costs <br />Total Due <br />Withholding <br />01/01/2016 - 12/31/2016 <br />04/16/2017 <br />130.00 <br />38.00 <br />1.61 <br />.00 <br />169 -61 <br />Total <br />169.61 <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 />11182350 <br />Federal ID Number <br />452560681 <br />Lien Serial Number <br />11790483 <br />Llen Filed With: <br />Social Security Number <br />XXX-XX-8212 <br />Spouse's Social Security Number <br />pi Register or Deeds ❑ County Clerk <br />Date of Lien <br />June 30, 2017 <br />Lien Type: <br />❑Corrected <br />County <br />BALL <br />1a Original []Continuation <br />Jul, 6. 2017 3:11FM NE cretary State — UCC No. 1308 <br />Nebraska Department of <br />REVENUE <br />sign <br />here <br />Business Name and Location Address <br />AUthori2ed Signature <br />201704524 <br />Notice of State Tax Lien <br />Taxpayer Name and Mailing Address <br />EDWARD SABATKA <br />1523 S LINCOLN AVE <br />GRAND ISLAND NE 68801 <br />NI Soo of 51.40 John a Ga e - UGC STL <br />II <br />9917794667 -3 Pes. 1 <br />SRBRTI(R EDWARD <br />Filed: 07/06/2017 09:16 AM <br />I certify 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 Mal ttte taxpayer nes tailed to pay Ina amount due after demand. This Notice al State Tax Lien is en effective lien and serves to continue the priority of <br />the S . e's interest in the affected props I the taxpayer, <br />Revenue Senior Agent 06/30/2017 402- 471 -5727 <br />Title Date Phi n ti me r <br />Revenue Senior Agent ' 0 <br />Title Dale <br />4-494 -1974 Rev. 8-2013 Supersedes 4 - 949 - 1974 Rev. 2 -2002 <br />A <br />