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Good Life. Great Service. <br />DEPARTMENT a REVENUE <br />Notice of State Tax Lien <br />202601633 <br />Nebraska Secretary of State <br />-FILED- <br />File #: 2603058419-2 <br />Date Filed: 3/17/2026 11:53 AM <br />C0523-1862 03/17/2026 8:08 <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 lien.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 />1 <br />i <br />i <br />1 <br />i <br />Nebraska ID Number <br />24010936 <br />Federal ID Number <br />NO FEIN <br />f <br />Lien Serial Number <br />12623312 <br />Lien Filed With: <br />14 Register of Deeds <br />❑ County Clerk <br />Social Security Number <br />XXX XX-3624 <br />Spouse's Social Security Number <br />NO SPOUSE SSN <br />i <br />Date of Uen <br />January 29, 2026 <br />Lien Type: <br />Continuation ❑Corrected <br />County <br />HALL <br />' <br />I4 Original <br />Business Name and Location Address <br />Taxpayer Name and Mailing Address <br />MICHELLE L ULDRICH <br />1414 N CLARK ST <br />GRAND ISLAND NE 68801 <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 />2024 <br />06/25/2025 <br />$502.00 <br />$25.10 <br />$31.80 <br />$558.90 <br />Total <br />$558.90 <br />f 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 />Revenue Manager <br />Title <br />Revenue Supervisor <br />01/29/2026 (402)471-5729 <br />Date Phone Number <br />01/29/2026 <br />0 <br />r1, <br />cn <br />rt <br />a <br />rt <br />0 <br />Authorized Signature <br />Title Date <br />4-494-1974 Rev. 8-2018 Supersedes 4-949-1974 Rev. 8-2013 <br />