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Tax Program Tax Period Date of Assessment Tax Penalty Interest _ Costs Total Due Withholding 07/01/2014 - 05/14/2018 1,831.00 971.25 294.25 .00 Total 3,096.50 3,096.50 _1_2/_3 This Notice of State Tax Lien is issued by the Nebraska Department of Revenue for unpaid taxes administered by the Tax Commissioner. Taxes, including penalties, interest, and costs, which are shown below, are due from the taxpayer and remain unpaid after demand.These taxes are a lien for all property located in the county and rights to property owned by the taxpayer or acquired before the expiration of this lien.This lien will expire and become unenforceable 10 years after the date of recording if no continuation statement is recorded on or prior to the expiration of the previous lien or continuation statement PLEASE DO NOT WRITE IN THIS SPACE Nebraska ID Number 11305312 Federal ID Number 454762258 Lien Serial Number 11809799 Llen riled With: Social Security Number _ -8774 Spouse's Social Security Number ' Register of Deeds • County Clerk Date of Lien July 11, 2018 Lien Type: County HALL 4 Original • Continuation • Corrected Jul. 13. 2018 2:27PM NE Secretary o state 201804500 08 Nebraska Department of REVENUE sign here Prepa Business Name and Location Address I certify that the Nebraska Department r has faNe• to pay the In The :9' - . proper Authorized Signature Notice of State Tax Lien Revenue Agent Title Revenue Senior Agent Title NI Sea of 5 eta Jehn A e. e - UCC STL iN No. ',1627 P. 4.4 11 9918813574 -4 Pas: GREEN JAMIE Filed: 17/19/2618 01:ee PM Taxpayer Name and Mailing Address JAMIE GREEN SWEET ANGELS CHILI) LEARNING CENTER LLC 608 N FILLMORE AVE HARVARD NE 68944 1 avenue has complied with the laws of the State of Nebraska in determining the amount shown to be due, er demand. This Notice of Stale Tax Lien is en effective lien and serves to continue the priority of 402- 471 -5788 Phone Number 7 McP Date 44 Rmt tR,D13 cupemedos 4- 949.1174 Rau 2-2002