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Tax Program <br />Tax Period <br />Data of <br />Assessment <br />Tax <br />Penalty <br />Interest <br />Costs <br />Total Due <br />Sales <br />10/01/2015 - 12/31/2015 <br />02/01/2016 <br />_00 <br />.00 <br />.05 <br />,00 <br />.05 <br />Sales <br />01/01/2016 - 03/31/2016 <br />05/02/2016 <br />.00 <br />.00 <br />.14 <br />.00 <br />.14 <br />Sales <br />07/01/2013 - 06/30/2016 <br />09/13/2016 <br />31,651.02 <br />4,220.21 <br />3,253.40 <br />.00 <br />39,124.63 <br />Total <br />39,124.82 <br />Jar.31.2018 11PMl NE Secretary of 'State <br />Nebraska Deportment 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.Thesetaxes 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 ilen.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 ID Number <br />9767118 <br />Lien Serial Number <br />11899737 <br />Dale of Lien <br />January 18, 2018 <br />Lien Flied With: <br />® Register of Deeds ❑ County Clerk <br />Business Name and Location Address <br />sign <br />here Prepar <br />Notice of State Tax Lien <br />PLEASE DO NOT WERE IN THIS SPACE <br />Federal ID Number <br />Social Security Number <br />XXX -XX -1518 <br />ME Sam of ahn (r Sala - UCC 5TL <br />I��i I I <br />��III <br />' . I I l i'i III! II <br />9918805471 -4 Pas: 1 <br />GARCIA LETT <br />Filed: 01131/2018 09:48 AM <br />Lien Type: County <br />Original E3 Continuation EJSe.Tocled HALL <br />Taxpayer Name and Meiling Address <br />LETY GARCIA <br />405 N PINE ST <br />GRAND ISLAND NE 68801 <br />N P. 2 <br />201800639 <br />Spouse's Social Security Number <br />I certify that the Nebraska Department of Revenue has complied with the laws of the State of Nebraska In determining the amount shown to be due, <br />and that the taxpayer has felled to pay the amount due alter demand. Thia Notice of Stale Tax Lien is an effective lien and serves to continue the priority of <br />Intermit in the affected p + I <br />Revenue Agent 01/11/2018 402 -471 -5717 <br />Title Dale Phone Nun <br />Revenue Senior Agent /1)--? <br />Authorized Signature Title Date <br />4.194-1974 flea 64019 Supersedes 4940074 Rev. 2-2002 <br />