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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 />2011 <br />03/07/2015 <br />$1,233.31 <br />$62.81 <br />$222.65 <br />County <br />HALL <br />1,518.77 <br />Total <br />$1,518.77 <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 tien.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 />PLEASE RETURN TO: <br />NEW AS,KA.DEPT OF REVENUE <br />PO BOX 94609 <br />LINCOLN NE 68509 -4609 <br />Nebraska ID Number <br />44176686 <br />Federal D Number <br />Lien Serial Number <br />11795162 <br />Lien Filed With: <br />Social Security Number <br />XXX -XX -4668 <br />Spouse's Social Security Number <br />FA Fleglster of Deeds County Clerk <br />bate of Llen <br />October 04, 2017 <br />Lien type: <br />J Original Continuation DCorreeted <br />County <br />HALL <br />t <br />Oct, 10. 2017 3:48 PM <br />Nebraska Department of <br />REVENUE <br />sign <br />here Preparer's <br />Business Name and Location Address <br />I certify that the Nebraska Department of Revenue has compiled with the laws of the State of Nebraska in determining the amount shown to be due, <br />and that the taxpayer has - _ to pay t , • ount 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 th =1�y e• • op ty of t e tax <br />—.11 ROM inale ra Ill t1,11• <br />Authorized signature <br />201706883 <br />Notice of State Tax Lien <br />Revenue went <br />igna ure itle <br />s iZtifina. scar <br />Title <br />ci.4299 P. 6/6 <br />NE Sr a of Siena John A Gale - UCC STL <br />9917799485 -2 Pas 1 <br />COLLISTCR DALLAS S <br />Filed, i0/10/2017 03:16 PM <br />Taxpayer Name and Mailing Address <br />'DALLAS S COLLISTER <br />508 E BISMARK <br />GRAND ISLAND NE 68801 <br />10/04/2017 (308)632 -1206 <br />Date Phone Number <br />10/04/2017 <br />Date <br />d494 - 1974 Rev. 5-2012 Supersedes 44040.1074 Rev. 2 -2 <br />