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Aug. 9. 2018 9:12AM \JE Secretary of State <br />Nebraska Peparcmenr of <br />REVENUE <br />Lien Serial Number <br />11811289 <br />Date of Lien <br />August 02, 2018 <br />sign <br />here <br />Lien Type: <br />® Original <br />Business Name and Location Address <br />Notice of State Tax Lien <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 Iien.Thls lien will expire and <br />become unenforceable 10 years after the date of recording It 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 />45748225 <br />Lien Filed With <br />® Register of Deeds D County Clark <br />Federal U Number <br />Social Security Number <br />XXX- XX4542 <br />Continuation ['Corrected <br />N3, 1)758 F. 2 <br />201805170 <br />NE Say of 54ete John A 6e►e - LUC STL <br />9918817386 -5 Pga: 1 <br />CHAPEL COLLETTE R <br />Filed: 00/00/2010 10:12 RM <br />PLEASE DO NOT WRITE IN THIS SPACE <br />Spouse's Social Security Number <br />XXX -XX -9480 <br />County <br />HALL <br />Taxpayer Name and Mailing Address <br />COLLETTE R CHAPEL <br />TYRON L CHAPEL <br />404 CAROLINA AVE <br />RALEIGH NC 27606 -0372 <br />Tax Program <br />Individual <br />Tax Period <br />2012 <br />Date of <br />Assessment <br />03/03/2017 <br />Tax <br />$476.00 <br />Penalty <br />$119.00 <br />Interest <br />$75.70 <br />Costs <br />Total <br />Total Due <br />670.70 <br />$670.70 <br />I certify that the Nebraska Department of Revenue has complied with the laws of the Mate of Nebraska In determining the amount shown to be due, <br />and that the taxpayer has felted to pay the amount due after de rnend.This Notice of Slate Tax Lien is an effective Ilan and serves to continue the priority Of <br />the State's interest In the affec property of the taxpayer. - <br />Revenue Agent 08/02/2018 (308)632 -1203 <br />Title Date Phone Number <br />Revenue Supervisor 08/02/2018 <br />Azad Signature Tee Date <br />4 -4 94.1974 Aev &2013 Bupersedee 4-949 -1E74 fiev.2-2002 <br />