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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 />2012 <br />07/17/2016 <br />$3,053.88 <br />$152.69 <br />$477.16 <br />3,683.73 <br />Individual <br />2 <br />10/21/2015 <br />$1,954.00 <br />$129.15 <br />$208.50 <br />2,291.65 <br />Total <br />$5,975.38 <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 />. <br />Nebraska ID Number <br />32207743 <br />Federal ID Number <br />Lien Serial Number <br />11809317 <br />Lien Filed Wilh: <br />Social Security Number <br />)()(X -)p( -6623 <br />Spouse's Social Security Number <br />XXX -XX -2295 <br />r4 Register of Deeds Q Count clerk <br />Date of Lien <br />June 29, 2018 <br />Lien Type: <br />❑carrectzd <br />County <br />HALL <br />LR] on b I1 ContFnu bon <br />Jul. 5.2013 3:125M <br />Nebraska Department of <br />REVENUE <br />E Secretary of State <br />Business Name and Location Address <br />201804316 <br />Notice of State Tax Lien <br />Revenue Agent <br />TIlIe <br />Tax <br />True <br />Revenue Supervisor <br />Ni See of flake John A Garr <br />99 — <br />WELSH MICHREL 7 S <br />Filed: 07/0812018 11 :08 <br />PLEASE RETURN TO: <br />NEBRASKA DEPT OF REVENUE <br />PO BOX 94609 <br />LINCOLN NE 68509 -4609 <br />a er Name and Mailing Address <br />MICHAEL S WELSH <br />SUSAN M WELSH <br />1832 N KRUSE AVE <br />GRAND ISLAND NE 68803 <br />., 0566 F. 2 <br />- UGC TL <br />certify that the Nebraska Department of Revenue hes complied with the laws of the State of Nebraska in determining the amount shown to be due, <br />and that the taxpayer has Failed to pay the amount clue alter oemand.Thts Nollce of State Tax Lien Is an effective wen and serves to continue the pfrority 01 <br />the Stale% interest in the affected property of the taxpayer. <br />06/29/2018 (308)632 - 1203 <br />Dale Phone Number <br />06/29/2018 <br />Dale <br />4-494-1974 Rev. 8 2013 Supersedes 4-949-1974 flev.2-2002 <br />