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Tax Program Tax Period Date of Assessment Tax Penalty Interest Costs Total Due Individual 2013 07/05/2017 $373.05 $18.65 $40,14 431.84 Total $431.84 This Notice of State Tax Lien is issued by the Nebraska Department of Revenue for unpaid taxes administered by the Tax Commissioner. Taxes, including penalties, interest, and costs, which are shown below, are due from the taxpayer and remain unpaid after demand.These taxes are a lien for all property located in the county and rights to property owned by the taxpayer or acquired before the expiration of this Iien.This lien will expire and become unenforceable 10 years after the date of recording if no continuation statement is recorded on or prior to the expiration of the previous lien or continuation statement. PLEASE DO NOT WRITE IN TNIS SPACE Nebraska ID Number 37625593 Federal D Number Lien Serial Number 11797389 Lien Fled With; ® Register oI Deeds ❑ County Clerk Social Security Number XXX4O(.5569 Spouse's Social Security Number Date of Lien November 14, 2017 Lien Type: ® original ❑Continuation County HALL i)♦ Corrected Nov. 17. 2017 3:19FM NE Secretary of State — UCC Nebreaka Deperxmenl of REVENUE Business Name and Location Address Notice of State Tax Lien Tax NE S.c nv 7.401.2 J ohn TIMOTHY L THIEDE 2122 CIRCLE DRIVE GRAND ISLAND NE 68801 2412'707 Cole - UtC it TL Pear 1 9917ae1Be6 -9 THIEDE TII10 ?NY L Filed; 11/17/2017 01:47 PM ayer Name and Mailing Address cenily that the Nebraska D mem of Revenue has compiled with the laws of the State of Nebraska In determining the amount shown to be due. a .:yer has faded y the mount due after demand. This Notice of State Tax Lien is an effective nen and serves to conrtnue the priority of fleet Revenue Agent 11/14/2017 (402)471 -5928 Tine Date Phone Number Revenue Supervisor 11/14/2017 Tide Date 4. 414 4-1974 Rev 9 -20,3 Supereedes4- 949.1974 Rev. 2-2002