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ui. 9. 2013 3:36FM NE Secretary of State2 0 f 8 0 4 3 9 N <br />08 <br />Nebraska Department of <br />REVENUE <br />This Notice . of State Tax Lien 1s 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 Pen wilt 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 />32344317 <br />Lien Serial Number <br />11809577 <br />Date of Lien <br />July 06, 2018 <br />Lien Feed With: <br />® Register of Deeds County Clerk <br />Lien Type: <br />® Original <br />Business Name and Location Address <br />Notice of State Tax Lien <br />Federal ID Number <br />Social Security Number <br />XXX -XX -1503 <br />ID Continuation ['Corrected <br />Revenue Agent <br />NE Sac of Si 1e Jehn a Gal& - 6ICC STL <br />9918815259 —G y e : <br />KURZ DEVON J <br />Filed: 07/09/2018 01 :59 Pp <br />pLEASE DO NOT WRITE IN THIS SPACE <br />PLEASE RETURN TO: <br />NEBRASKA DEPT OF REVENUE <br />PO BOX 94609 <br />LINCOLN NE 68509 -4609 <br />DEVON J KURZ <br />2011 W 11TH STREET <br />GRAND ISLAND NE 68803 <br />Nc. 0579 F. 2 <br />Spouse's Social Security Number <br />covnry <br />HALL <br />Taxpayer Name and Mailing Address <br />certify that the Nebraska Department of Revenue has complied with Fhe laws of the Slats of Nebraska In determining the amount shown to be due, <br />and that the taxpayer has tale. • = the aounl due after demand. This Notice of State Tex Lien is an effective len and serves to continue the priority of <br />the Stale'a interest In the a!fe <br />Tax Program <br />Individual <br />Tax Period <br />2016 <br />Date of <br />Assessment <br />11/29/2017 <br />Tax <br />$531.00 <br />Penalty <br />$36.09 <br />Interest <br />$19.47 <br />Costs <br />Total <br />Total Due <br />586.56 <br />$586.56 <br />07/05/2018 (308)632 -1206 <br />pate Phone Number <br />07/05/2018 <br />The <br />Revenue Supervisor <br />Tide Date <br />4-4944974 Rev. &2013 Supersedes 4-949 -1974 Rev. 2-2002 <br />