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Tax Program <br />Tax Period <br />bate of <br />Assessment <br />Tax <br />Penalty <br />Interest <br />Costs <br />Total Due <br />Sales <br />01/01/2013 - 12/31/2013 <br />08/12/2014 <br />4,280.00 <br />856.00 <br />414.80 <br />.00 <br />5,550.80 <br />Sales <br />01/01/2014 - 1.2/31/2014 <br />08/11 /2015 <br />5,350.00 <br />1,070.00 <br />358.34 <br />.00 <br />6,778.34 <br />Total <br />12,329.14 <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 />PLEASE DO NOT WRITE IN THIS SPACE <br />Nebraska ID Number <br />5889715 <br />Federal 0 Number <br />Lien Serial Number <br />11786530 <br />Llen Filed Wllh: <br />El Register of Deeds County Clerk <br />Social Security Number <br />XXX -XX -2485 <br />Spouse's Social Security Number <br />Date of Lien <br />April 14, 2017 <br />Llen Type: <br />County <br />HALL <br />1y original ā¯‘Continuation <br />II Corrected <br />Jul. 12. 2017 1:48FM <br />V' V <br />Nebraska Department of <br />REVENUE <br />sign <br />here <br />Business Name and Location Address <br />20170465 <br />Notice of State Tax Lien <br />N . 4080 F. 2/2 <br />'t£ Sec of 54a a John R e.L - IJCC STL <br />9917794827 -3 Pam: <br />W NTKR DOUGLAS G <br />Flied: 07/12/2017 09;68 AIM <br />Taxpayer Name and Mailing Address <br />DOUGLAS C WINTER <br />4879 N ST PAUL RD <br />GRAND ISLAND NE 68801 <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 De clue, <br />and that the taxpayer has failed to pay the amount due after demand.This Notice of State Tax Lien is an effective lien and serves to continue the priority of <br />the State's interest in the affected property of the taxpayer. <br />reparers 8T i ature <br />A uth o riz ed Signature <br />7- w 17 <br />Revenue Senior Agent - 1147 402 -471 -5727 <br />Title Date Phone Number <br />Revenue Senior Agent 7-1047 <br />Title Date <br />4 -4 4 -1974 Rev, &2013 Supersedes x949 -1974 Aev. 2 -2002 <br />