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Tax Program <br />Tax Period <br />Date of <br />Assessment <br />Tax <br />Penalty <br />Interest <br />Costs <br />Total Due <br />Individual <br />2010 <br />05/19/2017 <br />$1,636.00 <br />$409.00 <br />$420.38 <br />2,465.38 <br />Individual <br />2012 <br />05/19/2017 <br />$1,516.00 <br />$379.00 <br />$246.46 <br />2,141.46 <br />Individual <br />2013 <br />05/19/2017 <br />$1,761.00 <br />$440.25 <br />$233.47 <br />2,434.72 <br />Total <br />$7,041.56 <br />6 c1 <br />Sep. 1O 2013 15FM NE ...r-tary ,t tat- <br />Good Life. Great Service. <br />cEM0.T11PNT A; ;MOW. <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.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 />Nebraska 1D Number <br />36509892 <br />Lien Serial Number <br />11814219 <br />Date of Lien <br />September 14, 2018 <br />sign <br />here <br />Notice of State Tax Lien <br />Lien Filed With' <br />Register of Deeds El County Clark <br />Federal ID Number <br />Social Security Number <br />XXX- XX-5058 <br />Lien Type: <br />® Original D Continuation D Corrected <br />Business Name and Location Address <br />Title <br />PLEASE DO NOT WRITE IN THIS SPACE <br />County <br />HALL <br />CRISPIN C CIPRIAN <br />811 W JOHN ST <br />GRAND ISLAND NE 68801 -6749 <br />Nc. (966 F. <br />201806134 <br />N G Se= oT 54a4e John a Ga 1u - UCC ITL <br />9918819605 - 1 Pgs <br />C PR AN CRISPIN C <br />Ft1.de 09/10/2018 11:21 AM <br />Spouse's Social Security Number <br />Taxpayer Name and Mailing Address <br />• <br />I certify That the Nebraska Department of Revenue has complied with the laws of the Stale of Nebreeke in determining the amount shown lo be due. <br />and that the taxpayer has failed to pay the amount due alter demand.'lhls Notice of Stale Tax Lien Is an effective Ilea and serves to continue the priority of <br />the Slate's interest in the affected property or the taxpayer. <br />Revenue Agent 09/14/2018 A402)471 -5712 <br />Title Dale Phone Number <br />Revenue Supervisor 09/14/2018 <br />Date <br />4. 484 -1G74 REV 8-2018 Superedee 4-549-1971 Rev. e- 13 <br />c . <br />