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Tax Program Tax Period Date of Assessment Tax Penalty Interest Costs Total Due Individual 2016 05/24/2017 $2,709.00 $135.45 $102.65 2,947.10 Total $2,947.10 Jul. 26. 2018 3:22FM NE Secretary of State Nebreeke Department of REVENUE 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. T hese 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. Nebraska ID Number 41005538 Lien Serial Number 11810394 Dale of Lion July 20, 2018 sign here Pre rig Original Business Name and Location Address Notice of State Tax Lien Uen Flied With: ® Register of Deeds [1 County Clerk Lien Type: ❑ Continuation property of the taxpayer. p i Authorized Sign Title PLEASE DO NOTWRITE INTNIS SPACE Federal ID Number social Security Number XXX4X -5264 0 Corrected No. 0670 F. 2 201804832 NE Sec of stele John A Amle - UCC STL 9918816590 -9 PUS : 1 ACEVEDO ALEX F11ed: 07/2612010 02:42 PM ALEX ACEVEDO 817 W 16TH GRAND ISLAND NE 68801 Spouse's Social Security Number y HALL Taxpayer Name and Mailing Address certify Ihet the Nebraska Department of Revenue has complied wlth the laws of the Siete of Nebraska In determining the amount shown to be due, and that the taxpayer has failed to pay the amount due after demand. This Nolte of Slate Tax Lien Is an effective Men and serves to continuo the prlortty of Ole Slate's interest in the a Revenue Agent 07/20/2018 (308)632 - 1203 Tiue bate Phone Number Revenue Supervisor 07/20/2018 Date 4.4941974 R. 8-2013 Eupereedes 4.919 -1974 Rev. 2-2002 ' \1