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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 />Sales <br />01/01/2017. 12/31/2017 <br />.05/04/2018 <br />705.00 <br />141.00 <br />L05 <br />-00 <br />854.05 <br />Total <br />854.O5 <br />Jun.13. 2018 ':29P <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 Ilen 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 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 />5889715 <br />Lien Serial Number <br />11808197 <br />Date of Lien <br />,tune 8, 2018 <br />sign <br />here <br />P eparer -tgn 4971 <br />Authorized Signature <br />Vl NE 'Secretary of State — UCC <br />Notice of State Tax Lien <br />Lien Filled With <br />® Register of Deeds 0 County Clerk <br />Lien Type: <br />® original ❑ Continuation 0 Corrected <br />Business Name and Location Address <br />201803774 <br />PLEASE DO NOT WRITE IN THIS SPACE <br />Federal ID Number <br />Social Security Number <br />XXX -XX -2485 <br />DOUGLAS C WINTER. <br />4879 N ST PAUL RD <br />GRAND ISLAND NE 68801 <br />No. 4667 F. <br />NE Sao of S4 +., .1131.1 <br />.1 A Gala - uCC SY%. <br />111 11 <br />I <br />I <br />9 e 18 s13se1-1 <br />WINTER b0UGLpS C pas: 1 <br />Filed: OS/13/201B 1 1:23 Ain <br />Spouse's Social Security Number <br />County <br />HALL <br />Taxpayer Name and Mailing Address <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 fatted to pay the amount due after demand. This Notice oI Stale Tax Lien is an effective Ilen and serves to continue the priority of <br />the Slate's interest In the affected properly of the taxpayer. <br />Revenue Senior Agent 06/08/2018 402 - 471 -5727 <br />Title Date Phone Number <br />Revenue Senior Agent & <br />Title Date <br />4 Rev. B -2019 Supersedes 1 -949 -1974 Res 2.2002 <br />