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Good Life. Life. Great Service. <br />p[MRTNINT 0 IIIVDNII[ <br />Notice of State Tax Lien <br />2026n1871 <br />Nebraska Secretary of State <br />-FILED- <br />File #: 2603064165-3 <br />Date Filed: 3/26/2026 9:33 AM <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 />Nebraska ID Number <br />43388876 <br />Federal ID Number <br />NO FEIN <br />Uen Serial Number <br />12625122 <br />Uen Filed With: <br />Ii Register of Deeds ❑ County Clerk <br />Social Security Number <br />XXX-XX-0746 <br />Spouse's Social Security Number <br />XXX-XX-4856 <br />Date of Uen <br />February 6, 2026 <br />Uen Type: <br />❑Corrected <br />County <br />HALL <br />K4 original Continuation <br />Business Name and Location Address <br />Taxpayer Name and Mailing Address <br />ANDREW PETERSEN <br />KELLY PETERSEN <br />PO BOX 27 <br />DONIPHAN NE 68832 <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 />05/09/2025 <br />$2,988.00 <br />$149.40 <br />$194.51 <br />$3,331.91 <br />Total <br />$3,331.91 <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 0- Preparers Signature <br />Authorized Signature <br />ram; <br />Revenue Manager 02/06/2026 (402)471-5729 <br />Title Date Phone Number <br />Revenue Supervisor 02/06/2026 <br />Title Date <br />4-494-1974 Rev. 8-2018 Supersedes 4-949.1974 Rev. 8-2013 <br />C0524-4507 03/26/2026 8:08 <br />Received by Nebraska Secretary of State <br />