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Tax Program Tax Period Date of Assessment Tax Penalty Interest Costs Total Due Sales 09/01/2017 - 11/30/2017 01/02/2018 245.46 75.00 10.68 100.00 431.14 Sales 01/01/2018 - 01/31/20I8 05/06/2018 130.00 46.50 2.67 .00 179.17 Sales 12/01/2017 - 12/31/2017 05/06/2018 3.48 46.50 2.09 .00 52.07 Sales 02/01/2018 - 02/28/2018 06/01/2018 145.99 25.00 2,02 .00 173.01 Sales 03/01/2018 - 03/31/2018 06/01/2018 165.29 25.00 1.86 100.00 292.15 Sales 06/01/2018 - 06/30/2018 07/11/2018 .76 .00 .00 .00 .76 Sales 04/01/2018 - 04/30/2018 08/01/2018 .00 25.00 .56 .00 25.56 Sales 05/01/2018 - 05/31/2018 08/01/2018 44.31 .00 .30 .00 44.61 Sales 07/01/2015 - 08/31/2017 _00 .00 61.57 .00 61.57 Total 1,260.04 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 11187581 Federal ID Number 454473628 Lien Serial Number 11813402 Lien Filed With: Social Security Number XXX -XX-7527 Spouse's Social Security Number j Register of Deeds County Clerk Dale of Lien September 4, 2018 Lien Type: 0 Corrected County HALL i ka Original 0 Continuation 2 0 1 8 1 0 P M N E S e c r e t a r y o f S t a t e - UCC 2 O I Q2 8 5 O2 Nebrastta Department of REVENUE sign here Business Name and Location Address epa s Sig ure Authorized Signature Notice of State Tax Lien Title N[ sac of St. axpayer Name and Melli Atlaress RODRIGO SANCI -IEZ 316E2NDST GRAND ISLAND NE 68801 aeio 9918818996 -1 SANCHEZ RODRIGO Filed, 09/ 06/2018 10:55 AM ucc sYL Pus 1 I certify that the Nebraska Department of Revenue has complied with the laws of the Slate of Nebraska In determining the emounl shown to be due, and that the taxpayer has hailed to pay the amount due after demand. This Notice of State Tax Lien is an effective lien and serves to continue the prrority of the S :1e's interest In the affects. property of the laxpayer. Revenue Senior Agent 09/04/2018 402 -471 -5727 Title Date Phone Number Revenue Senior Agent 9 Date 4 - 494.1974 Rev. 8 Supersedes 4 - 94e - 1974 Rev. 2 - 20112 /l-.