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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 />2013 <br />05/21/2016 <br />$1,919.02 <br />$95.95 <br />$217.66 <br />IKI original ■ Continuation <br />2,232.63 <br />Total <br />$2,232.63 <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 pr <br />acquired before the expiration of this IIen.Thls Ilen 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 />. <br />. <br />Nebraska ID Number <br />96201320 <br />Federal D Number <br />Lien Serial Nurnber <br />11800589 <br />Lien Fled With: <br />Social Security Number <br />XXX -XX -6426 <br />Spouse's Social Security Number <br />(A Register of Deeds ■ County Clerk <br />Date of Lien <br />January 24, 2018 <br />Lien Type: <br />County <br />HALL <br />IKI original ■ Continuation <br />S Corrected <br />Jan.30.2018 4:02PN1 <br />PLEASE RETURN TO: <br />NEBRASKA DEPT OF REVENUE <br />PO BOX 94609 <br />LINCOLN NE 68509 -4609 <br />Nebraska Department of <br />REVENUE <br />sign <br />here <br />Business Name and Location Address <br />and <br />Ih <br />Preparers spinature <br />itah . <br />Authorized Signature <br />NE Secretary of State 201800612- N 0.0013 P. 2 <br />Notice of State Tax Lien <br />E 5ec of 54ai• Jahn H gal• - UCC StL <br />9918805355 -8 Pge: 1 <br />DAVIS MICHAEL <br />Filed= ._01/80/2019..01:67 PM <br />Taxpayer Name and Mailing Address <br />MICHAEL DAVIS <br />1411 W STOLLEY PARK DR APT B <br />GRAND ISLAND NE 68801 <br />_ Department of Revenue has compiled With the laws Of the State of Nebraska In determining the amount shown 10 be due, <br />failed to pay the amount due after demand. This Notice of State Tax Lien is an effective lien and serves to continue the priority of <br />affected properly or the taxpayer. <br />Revenue Agent 01/24/2018 (308)632 -1210 <br />Tllle Dale Phone Number <br />. J�t� i L 01/24/2018 <br />Tate 1 Date <br />4-494w1916 Rev, e supersedes 4-049-1574 RSV. 2 <br />