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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 />2015 <br />05/24/2016 <br />$678.90 <br />$72.15 <br />$53.67 <br />604.72 <br />Total <br />$804.72 <br />This Notice of State Tax Llen 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 if 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 tD Number <br />99354128 <br />Federal ID Number <br />Lien Serial Number <br />11808899 <br />Llen Filed With: <br />Social Security Number <br />)0(X -XX -3319 <br />Spouse's Social Security Number <br />XXX -)X -8174 <br />i7 Register of Deeds • County Clerk <br />Dale of Lien <br />June 22, 2018 <br />lien type: <br />❑Corrected <br />County <br />HALL <br />A original • Continuation <br />Jun. 27. 2018 2:28FM NE Secretary of State <br />Neon eke Deportment of <br />REVENUE <br />sign <br />here <br />Business Name and Location Address <br />OILS <br />Prep = Signature <br />prized Signature <br />Notice of State Tax Lien <br />9918814632-7 Pas I <br />20180912 i <br />Taxpayer Name and M ailing Address <br />SCOTT BENNETT <br />RACHEL BENNETT <br />501 SOUTH CEDAR STREET <br />GRAND ISLAND NE 68801 <br />NJ. 0532 <br />I certify that the Nebraska Department of Revenue has compiled with the laws of the State of Nebraska In delPe,rmining the amount shown to be due, <br />and that the taxpayer has faNed to pay the amount due after demand, Thia Notice of Stale Tax Lien is an effective Ifen and serves to continue the priority of <br />e State's interest In the affected property at the taxpayer. <br />Revenue Agent 06/22/2018 (402)471 -5712 <br />Title Data Phone Number <br />Revenue Supervisor 06/22/2018 <br />Title Date <br />4494-1674 Rev. 62013 eupeteedee 4 Rev 2 - 2002 <br />