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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 />Individual <br />2014 <br />07/30/2016 <br />$747.00 <br />$37.35 <br />$55.39 <br />839.74 <br />Total <br />$839.74 <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 Ilen.Thls 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 />98286897 <br />Federal ID Number <br />Lien Serial Number <br />11794987 <br />Lien Filed With: <br />Social Security Number <br />XXX- XX.8854 <br />Spouse's Social Security Number <br />II] Register of Deeds • Couny Clerk <br />Date of Lien <br />October 03, 2017 <br />Lien Type: <br />(XI Original ❑ Continuation • Corrected <br />County <br />HALL <br />Oct, 5. 2017 3:39PM NE Secretary of State — UCC 2 01, 7026 7P'9g <br />08 <br />Nebraska Department of <br />REVENUE <br />Business Name and Location Address <br />sign Q Cs - Whom <br />here Prey sSignature <br />llorized Signature Title <br />Notice of State Tax Lien <br />Revenue Agent <br />Tax <br />Title <br />Revenue Supervisor <br />NS Skm mg 51.10 Jahn q 6.r. - UCC STL <br />li ullI <br />I <br />9 917799302-6 519 : 1 <br />WENTZ STEVEN A <br />Filed: 10/05/2017 11 :04 nri <br />a er Name and Melling Address <br />STEVEN A WENTZ <br />2323 BELLWOOD DRIVE LOT 149 <br />GRAND ISLAND NE 68801 <br />certify that the Nebraska Department of Revenue has complied with the Taws of the State of Nebraska in determining the amount shown to be due. <br />end that the taxpayer has failed to pay the amount due after demand. This Notice of State Tax Lien is an effective Gen and serves to continue the priority of <br />the State's interest in the affected property of the taxpayer. <br />10/03/2017 (402)471 -5712 <br />Date Phone Number <br />10/03/2017 <br />Dale <br />4494 - 1974 Rev. 9.2013 Supersedes 4.5141 9.1974 Rex 2 - 2002 <br />