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Tax Program Tax Period Date of Assessment Tax Penalty Interest Costs Total Due Individual 2016 05/24/2017 $1,436.00 $89.81 $33.52 1,559.33 Total $1,559.33 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 alter 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 lien. 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 D0 N0T wri1TE IN THIS SPACE Nebraska ID Number 94571716 Federal ID Number Lien Serial Number 11800500 Uen Filed With Social Security Number XXX_XX -6558 Spouse'§ Social Security Number pi Register of Deada • County Clerk Date of Lien January 24, 2018 Lien Type; ❑ Corracled county HALL I':1 Original ❑Continuation Jan, 25. 2018 2:55PM NE Secretary of State — UCC b`) Nebraska Department of REVENUE Notice of State Tax Lien here Business Name and Location Address Tax Sae of 54ale Jahn P Gale - Ur.G STL 99188 06150 -4 Pgv. 1 ESCRLONR YOSt1ANY Filed: 01/261201 10•30 AM a er Name an Malin YOSUANY ESCALONA 504 NORTH ELM ST APT 232 GRAND ISLAND NE 68801 2 U 113 0 9 2, 2 ress I certify that the Nebraska Department of Revenue has complied With the laws d the Slate of Nebraska In determining the amount shown to be due, , nit that P. +sayer has failed to pay the amount due after demand. This Notice Or Stale Tax Lien is an effective Ilan and serves to continue the priority of Stale est In the affected property Of the taxpayer. Revenue Agent 01/24/2018 (402)471 -5731 Title Dale Phone Number Revenue Supervisor 01/24/2018 thorized Signature Title Date 4494.1974 Rev. 9 Supersedes 4. 040.1974 Rev. 2 -2002 11 .