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Good Life. Great Service. <br />DLMNTN[NT OF N[V{NY! <br />Notice of State Tax Lien <br />202601425 <br />Nebraska Secretary of State <br />-FILED- <br />File #: 2603052710-0 <br />Date Filed: 3/9/2026 9:31 AM <br />C0522-0435 03/09/2026 8:14 <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 />PLEASE DO NOT WRITE IN THIS SPACE <br />0 <br />c. <br />m <br />a <br />,-' <br />z <br />m <br />tr <br />n <br />a <br />03 <br />Nebraska ID Number <br />48039748 <br />Federal ID Number <br />NO FEIN <br />W <br />rn <br />Lien Serial Number <br />12621660 <br />Lien Filed With: <br />K4 Register of Deeds <br />Social Security Number <br />)()(X•X1' -4476 <br />Spouse's Social Security Number <br />NO SPOUSE SSN <br />CD <br />n <br />n <br />County Clerk <br />Date of Lien <br />January 20, 2026 <br />Lien Type: <br />County <br />HALL <br />1D <br />rr <br />a <br />n <br />r 4 Original <br />• Continuation <br />■ Corrected <br />Business Name and Location Address <br />Taxpayer Name and Mailing Address <br />SHANNON BURKS <br />431 PONDEROSA DR <br />GRAND ISLAND NE 68803 <br />Tax Program <br />Tax Period <br />Date of <br />Assessment <br />Tax <br />Penalty <br />Interest <br />Costs <br />Total Due <br />Individual <br />2023 <br />11/08/2024 <br />$12,749.74 <br />$946.00 <br />$2,035.06 <br />$15,730.80 <br />Total <br />$15,730.80 <br />I certify that the Nebraska Department of Revenue has complied with the laws of the State of Nebraska in determining the amount shown to be due, <br />and that the taxpayer has failed to pay the amount due after demand. This Notice of State Tax Lien is an effective lien and serves to continue the priority of <br />the State's interest In the affected property of the taxpayer. <br />sign <br />here Preparer's Signature <br />Authorized Signature <br />Revenue Manager 01/20/2026 (402)471-5729 <br />Title Date Phone Number <br />Revenue Supervisor 01/20/2026 <br />Title Date <br />4-494-1974 Rev. 8-2018 Supersedes 4-949-1974 Rev. 8-2013 <br />