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Tax Program Tax Period Date of Assessment Tax Penalty Interest Costs Total Due Individual 2014 11/12/2017 $1,148.00 $287 .00 $106.52 L1 original • Continuation 1,541.52 Total $1,541.52 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 after demand.These taxes are a lien for all property located hi 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 DO NOT WRITE IN THIS SPADE Nebraska ID Number 35236736 Federal ID Number Lien Serial Number 11806871 tJen Filed With: Social Seeur ty Number XXX -XX -7832 Spouse'e Social Secuttty Number `'4 Register of Deeds ❑ County Clerk Date of Lien May 18, 2018 Lien Type: County HALL L1 original • Continuation • Corrected May. 22. 2010 2:56PM NE Secretary of State Nebraska Department of REVENUE Sign here and the Business Name and Location Address I •- theNe horized Signature Notice of State Tax Lien KRIS A WILLIAMS 1815 S BLAINE ST GRAND ISLAND NE 68803 2014 0323 IdE 111111 Stee .IVhn A Gale - UCG STL 9918812084 -2 Pie: 1 WILLIAMS KRIS A Filed: 0 5/22/2018 10 A Taxpayer Name and Mailing Address at the to . 's Int ea Signature [• r� r, : PaY estinth flue nt d 05/18/2018 Dale Complied with the laws of the State of Nebraska In determining the amount shown to be due, tier demand. The Notice of State Tex Lien la en effective ten and serves to continue the prkxlty of Revenue Agent (402)471 -5789 Title Phone Number Revenue Supervisor 05/18/2018 Tide Date 4- 494 -1974 Rev. 11-2019 Supersedes 4- 949.1974 Rev.2 -2002