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Tax <br />Program <br />Tax period <br />Dale of <br />Assessment <br />Tax <br />Penalty <br />Interest <br />Costs <br />Total Due <br />Individual <br />2016 <br />05124/2017 <br />653.00 <br />32.65 <br />6.12 <br />691.77 <br />Total <br />$691.77 <br />61, <br />Aug, 9. 2017 2:55PM NE Secretary of State — UCC No. 1578 P. 2/2 <br />NeOlsul 7 0apanmenl 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 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 ii no <br />continuation statement is recorded on or prior to the expiration of <br />the previous lien or continuation statement. <br />Nebraska ID Number <br />93761465 <br />Lien Serial Number Lien Filed With: <br />11791999 © Register of Deeds ❑ County Clew <br />Date at Lien <br />08/0712017 <br />Lien Type: <br />® Original ❑ Continuation Corrected <br />Business Name and Location Address <br />sig <br />here Preparef <br />used Signature <br />201705 35 <br />Notice of State Tax Lien <br />PLEASE DO NOT WRITE IN THIS SPACE <br />Federal ID Number <br />Social Security Number <br />XXX -XX -9803 <br />COLBY BROWN <br />911 S LINCOLN AVE <br />GRAND ISLAND NE 68801 <br />NI Sec of Slate Jah. C fi.la - <br />Ila Y Int <br />9917796303 -5 <br />BROWN COLSr <br />Filed: 0a/a9/2017 09 :43 AM <br />Spouse's Social Security Number <br />County <br />HALL <br />Taxpayer Name and Mailing Address <br />Litt %1'L <br />Psis 1 <br />I certify that the Nebraska Department 01 Revenue has compiled wda the laws or the Slate of Nebraska in determining the amount shown to be due, <br />and that the taxpayer has fat pay the amount due attar demand. This Notice of Slate Tax Lien Is an effective lien and serves to continue the priority of <br />tale interest in the aft prop: of the taxpayer. <br />Revenue Agent 08/07/2017 (402)471 -5928 <br />Title Date Phone Number <br />Revenue Supervisor 08/07/2017 <br />Title Date <br />4- 4p4-1t14 par. 84013 Supersedes 4-919-1971 nay. 2 -2002 <br />