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Aug. <br />. 2017 4:06FM 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 <br />by ll property o payer or <br />in the county and rights to property <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 IC) Number <br />19337051 r <br />Lien Serial Number Lien Filed With: <br />11791744 © Rapider of Deed. [J Count clerk XXX- XX.467 <br />Date of Lien <br />08101/2017 <br />sign <br />here <br />Business Name and Location Address <br />Preparers Signature <br />endT ri ClnnaI ,r4 <br />Notice of State Tax Lien <br />Title <br />201'705204 <br />PLEASE DO NOT WHITE IN THIS SPACE <br />Federal ID Number <br />Social Seery Nutnbe <br />Lien Type: <br />Original f Continuation U Corrected <br />Taxpayer Name and Mailing Address <br />ELWYNE L MYERS <br />3024 GOLDENROD DR <br />GRAND ISLAND NE 68801 <br />Individual <br />bate of <br />Tax L Tax Period <br />Program Assessment <br />Tax <br />Penalty Interest Costs <br />2015 0612212016 274.00 13.70 10.65 <br />Total Due <br />298.35 <br />Total <br />$298.351 <br />I certify That the r hareska has tailed to p pay nt the of u alter complied demand. Van <br />ttis the o1 State State of Tax Lien s aanelf in <br />ective lien and serves amount shown to be due, the priority Cl <br />and Mat the taxpayer d to pay <br />the Slate's Interest In the allected property 01 the taxpayer. <br />Taxpayer Services Specialist II 0810112017 (402)471 -5729 <br />Phone Number <br />08/0112017 <br />Tide <br />Revenue Supervisor <br />County <br />HALL <br />Date <br />U. 1 530 <br />Spouse's Social Security Number <br />NE mc or si.i• ohn R de le - ULC alL <br />1 <br />9917796071 -2 Pea' <br />MYERS ELWYNE L <br />Filed; 00f081201 01;39 PM <br />pate <br />..,...n -.. <br />On o -nowl e..eere..le% 4- $10.1994 Asa 2 ,2002 <br />