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This Notice of State Tax Lien is issued by the Nebraska Revenue for unpaid taxes pursuant to the revenue laws Nebraska. Notice Is hereby given that taxes including penalties interest, which are shown below, are due from the taxpayer below and remain unpaid after demand. These taxes constitute in the county for real and personal property belonging or hereafter acquired. Department of of the state of and specified a lien to the taxpayer PLEASE DO NOT WRITE IN 'NS SPACE Nebraska Idenbfim ion Number 41736273 Federal Identlfrratlon Number Lien Serial Number 31920027 Lien Filed With RRe of Deeds Ocounty Clerk Social Security Number XXX -XX -6681 Spouse's Social 8ecunly Number Date of Lien 07/11/2003 Lien Type • •Origkml G CanthuaUon II Corrected County HALL BUSINESS NAME AND LOCATION ADDRESS TAXPAYER NAME AND MAILING ADDRESS T DAVID V GUERRA 422 N CLEBURN 3 GRAND ISLAND NE 68801 Tax Category Number . , Tax Period Date of Assessment Amount of Tax Penalty . Interest Additions Balance of Assessment Due 22 1999 05/15/2003 721.48 3807 19669 .00 958.44 . TOTAL $ 958.44 I hereby certify amount shown that the Nebraska Department a'Revenue to be due. and the taxpayer has failed has complied with the revenue laws of the State of Nebraska In the determination of the to nay the amount &4 afP• iI m nd If IbM NWvn of Sligo Tar r inn in an nwencLAn ..4 e.• Sep. 11. 2013 3:26PM NE Secretary of State — UCC sign here ► 201307440 Nebraska Department of REVENUE N www.rovenue.ne.gov U 0 �k�� g 10� C-E ' orni o I 1 (41 effective Gen, It serves continue the priority of the state's interest in the affected property of the taxpayer. Revenue Agent 1 / 10/L3 dle D5m Revenue Supervisor Title No. 0871 P. 5/6 NE 11 .c of State Jets 4 Gale . UCC SGON IIII 9913722631 -4 Pos; 1 GUERRA prVID V Filed: 09/11/2018 02 :30 PM TAX LIEN (402)471 -5928 Telephone Number Date 4.4941071 Rev. 2.200 Superset/ea 4 -494.1074 Nev. 10.1005