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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 />2010 <br />07/07/2017 <br />$436.00 <br />$109.00 <br />$106.91 <br />651.91 <br />individual <br />2011 <br />07/07/2017 <br />$9,602,00 <br />$2,400.50 <br />$1,873.05 <br />13,875.55 <br />Individual <br />2012 <br />07/07/2017 <br />$1,158.00 <br />$289.50 <br />$174.65 <br />1,622.16 <br />Individual <br />2013 <br />07/07/2017 <br />$1,015.0D <br />$253.75 <br />$122.63 <br />1,391.38 <br />Individual <br />2014 <br />07/07/2017 <br />$1,195.00 <br />$298.75 <br />$108.53 <br />1,602.28 <br />individual <br />2015 <br />07/07/2017 <br />$1,153.00 <br />$288.2 <br />$70.04 <br />1,511.29 <br />Total <br />$20,654.57 <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 or <br />acquired before the expiration of this lien. This lien will expire and <br />become unenforceable 10 years after the date of recording it 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 />Nebraska 10 Number <br />Federal ID Number <br />X8938 <br />Lien Serlai Number <br />11805527 <br />Lien Filed With: <br />J Register of Deeds I.J County Clerk <br />Social Security Number <br />XXX-XX -8929 <br />Spouse's Social Security Number <br />Date of Lien <br />April 24, 2018 <br />Lien Type: <br />[IQ Original Continuation ❑ Corrected <br />County <br />HALL <br />Apr, 26. 2013 3:37FM NE Secretary of State — UCC <br />0s <br />Nebraska Department of <br />REVENUE <br />Notice of State Tax Lien <br />Business Name and Location Address <br />I certify that the Nebraska Depanmenl of Revenue has complied with the laws of the Stale of Nebraska In determining the amount shown to be due, <br />and that the taxpayer has failed to pay the amount due after demand. this Notice of Slate Tax Lien Is an effective lien and serves to continue the priority of <br />T e . State's interest in the affected property of the taxpayer. <br />h er e Iglu <br />Preparer's ature <br />urban #e. Signature Title <br />NE Sac or I e4o Jahn R e.1. - <br />I <br />9918810410 -1 <br />HANSEN LARRY A <br />Filed: 04/29/2010 10:12 RA <br />Taxpayer Name and Malting Address <br />LARRY A HANSEN <br />2612 NORTH WEBB ROAD APT 9 <br />GRAND ISLAND NE 68803 <br />No.4255 F. 3 <br />2018026 4 <br />Pys <br />evenue A• ent 04/24/2018 (402)471 -5713 <br />Tide Date Phone Number <br />Revenue Supervisor 04 /24/2018 <br />Dale <br />4-494 -1074 Rev. 8 -2013 Supersedes 6-949.1974 Rev.2-2002 <br />