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Jun, 11. 2013 2 59FM NE .e._retary of Stat. — UCC <br />Nebraska Department 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.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 Iien.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 />39602893 <br />Lien Serial Number <br />11808153 <br />Dale of Lien <br />June 07, 2018 <br />Tax Program <br />Individual <br />sign <br />here <br />Prepare r <br />naklre <br />Auth ed Signature <br />Lien = dWith: <br />Negisleiof Deeds <br />Lien Typo: <br />® Ori <br />Business Name and Location Address <br />Tax Period <br />2016 <br />Notice of State Tax Lien <br />Date of <br />Assessment <br />11/01/2017 <br />El County Clerk <br />D Continuation <br />Social Sec <br />XXX <br />Tax <br />$2,499.00 <br />PLEASE DO NOT WRITE INTHIS SPACE <br />Federal ID Number <br />urlty Number <br />- XX -7106 <br />Q Corrected <br />Taxpayer <br />ERICK D NORVELL <br />CATHERYN M NORVELL <br />1603 COVENTRY LN <br />GRAND ISLAND NE 68801 <br />Penalty <br />$131.85 <br />Revenue Agent <br />Title <br />Revenue Supervisor <br />Tilte <br />Interest <br />$85.86 <br />2 : o3 6 6 <br />NE Sac of Star Join. R date - U <br />cc 5TH <br />21515613434-E 13434 -fi Pfd - °: <br />NOVELL ERICK 0 <br />Fllad: 06/11/2016 10'27 IR1 <br />Spouse's Social Security Number <br />XXX -XX -9252 <br />cwrny <br />HALL <br />Name and Mailing Address <br />Costs <br />I certify that the Nebraska Department oI Revenue hae complied with the laws of the State oI Nebraska In determining the amount shaven to be due, <br />and that the taxpayer has tailed to pay the amount due after demartd,Tt1s Notice of State Tax Lien is an edective Ilan and serves to Continue the priority of <br />the State's Interest in the affected property of the taxpayer. <br />06/07/2018 <br />Date <br />Total <br />Total Due <br />2,716.71 <br />$2,716.71 <br />(402 )471 -5712 <br />Phone Number <br />06107/2018 <br />Date <br />4 - 494 - 1974 Rev, 8-2012 Supersedes 4 -549 -1974 Rev. 2 -2002 <br />