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201' J � F J Secretary FM NE St f State — UCC. ------- - - - - -- -. Ma y.2 V J - - Nebraska Department of REVENUE Nebraska ID Number 91895154 Lien Serial Number Uen Filed With: 11806959 ® Register of Deals ❑ County Clerk Date of Lien Lien Type: May 21, 2018 g] original Q conllnuarlon Business Name and Location Address Tax Program Individual sign here al the S =. ='s in Pre s Signature partm opaY ed an In I c: al the Nebr ayer h eel In tnorized Signature Tax Period 2018 201803259 Notice of State Tax Lien 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 Ilen 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. Date of Assessment 10/31/2017 Federal ID Number Social Security Number XXX -XX -8204 0 Corrected Tax $477.00 PLEASE DO NOT WRITE INTHIS SPACE Taxpayer Name and Mailing Address DUSTIN MORFITT 1105 HALL COURT GRAND ISLAND NE 68801 Penalty $26.35 NE Sae of E4.k. iot,n 9918812255 -7 NORFITT DUSTIN Filed, 06/23/201U 10:03 RN Spouse's Sccial Security Number County HALL Interest $16.66 0. 4471 F. 2 Costs Total as complied with the laws of the State of Nebraska In determining the amount shown to be due, tier demand. This Notice of State Tax Lien is an effective lien and serves to continue the priority el eI. Total Due 520.01 $520.01 Revenue Agent 05/21/2018 (402)471 -5731 Title Dale Phone Number Revenue Supervisor 05/21/2018 Title Date 4 -404.1974 Rev. 8-2011 Supersede& 4.940.1974 Rev. 2-2002