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Tax Program <br />Tax Period <br />Date of <br />Assessment <br />Tax <br />Penalty <br />Interest <br />Costs <br />Total Duc <br />Sales <br />10/01/2016 - 03/31/2017 <br />03/01/2018 <br />553.29 <br />.00 <br />23.82 <br />.00 <br />577.11 <br />Sales <br />10/01/2017 - 12/31/2017 <br />03/01/2018 <br />975.84 <br />• 97.58 <br />13.89 <br />• .00 <br />1,087.31 <br />Sales <br />07/01/2017 - 09/30/2017 <br />03 /01/2018 <br />1,194.77 <br />119.48 <br />26.02 <br />.00 <br />1,340.27 <br />Sales <br />04/01/2017 - 06/30/2017 <br />03/01/2018 <br />868.75 <br />86.88 <br />25,48 <br />.00 <br />981.11 <br />Total <br />3,985.80 <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 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 10 Number <br />11606606 <br />Federal 0 Number <br />463320311 <br />Lien Serial Number <br />11809882 <br />_ <br />Lien Flied With: <br />Social Security Number <br />XXX XX -0469 <br />Spouse's Social Security Number <br />ri Register 01 Deeds U County Clerk <br />Oate of Lien <br />July 12, 2018 <br />Lien Type: <br />❑Corrected <br />County <br />HALL <br />EN original 0Continuation <br />11_11. 18. 2018 IOPM" NE Secretary of state — uc ? Nc.4662 F.. 2 <br />Nebraska Department of <br />R EVENUE <br />sign <br />here <br />Business Name and Location Address <br />Notice of State Tax Lien <br />NE SEC of Sf.ia <br />CASSIE PRICE <br />322 BUFFALO GRASS STREET <br />GRAND ISLAND NE 68803 <br />John R Ge la - UCC <br />9918816 03e -3 Pgs; <br />PRICE GASS E <br />Filed: 07/ e/201e 10:30 RA <br />Taxpayer Name and Mailing Address <br />I certify that the Nebraska Department or Revenue haS Complied wile the laws of the Slate of Nebraska in determining the arnount shown to be due. <br />and Thal the taxpayer has fatted to pay the amount due alter demand. This Nolloe of State Tax Lien is an effective lien and serves to Continue the priority of <br />the Stale'a interest in the affected property of the taxpayer. <br />TL <br />Revenue Agent 07/12/2018 402 - 471 -6067 <br />Title Date Phone Number <br />Revenue Senior Agent <br />Authorized Signature Title Dale <br />4.404 -1974 fiev. e-2013 Supersedes 4 -949 -1974 Fie... 2-2002 <br />A <br />