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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 />2009 <br />12/26/2016 <br />$3,852.00 <br />$963.00 <br />$1,095.34 <br />5,910.34 <br />Individual <br />2010 <br />12/26/2016 <br />$10,519.04 <br />$2,629.76 <br />$2,465.20 <br />15,614,00 <br />Individual <br />2011 <br />12/26/2016 <br />$13,742.61 <br />$3,822.00 <br />$2,531.65 <br />20,096.26 <br />Individual <br />2012 <br />12/26/2016 <br />$12,552.74 <br />$3,451.19 <br />$1,757.04 <br />17,760.97 <br />Total <br />$59,381.57 <br />oA <br />Dec. 18. 2017 2:58FM <br />PLEASE RETURN TO: <br />NEBRASKA DEPT OF REVENUE <br />PO BOX 94609 <br />LINCOLN NE 68509 -4609 <br />ltd /L�r- <br />NBbr9510a 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.Thesa 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 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 IO Number <br />47902086 <br />Lien Serial Number <br />11796674 <br />Date oI Llen <br />December 13, 2017 <br />sign <br />here <br />and <br />in <br />Business Name and Location Address <br />Prepare(' <br />Authonze. Signs <br />NE Secr etary of State — UCC <br />!len Filed With: <br />® Register of Deeds <br />Lien Type: <br />IN Original <br />Notice of State Tax Lien <br />❑ Count Cteru <br />O Con linuanon <br />PLEASE DO NOT WRITE IN THIS SPACE <br />Federal 0 Number <br />Social Security Number <br />XXX -XX -8194 <br />❑ Corr ected <br />Revenue Agent <br />Title <br />Revenue Supervisor <br />HG Svc of 5 eie John R Gole - UCC STL <br />2 5 5 <br />JACK J CULP <br />115 S BUFFALO RD <br />DONIPHAN NE 68832 <br />count <br />HALL <br />99178031E7 -5 Psis 1 <br />CULP JACK .3 <br />Filed: 12/10/2017 09:35 AM <br />Spouses Social Security Number <br />Taxpayer Name and Mailing Address <br />I certify at the Nee - eke Department of Revenue nee compiled wide the laws of the State of Nebraska in determining the amount shown to be due, <br />1. t : • r y en = s faked to pay the amount due after demand This ■otice of State Tax Llen le an effective lien and serves to continue the priority of <br />- affected property of the t. Ayer. <br />12/13/2017 <br />Oats <br />(308)632 -1210 <br />Phone Number <br />12/13/2017 <br />Title Oate <br />4- 494-1974 Rev. a-2013 Supersedes 4949 -1974 Aev, 24002 <br />