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Tax Program <br />Tax Period <br />Tax <br />of <br />Penalty <br />Interest <br />Costs <br />Total Due <br />Individual <br />2013 <br />03/04/2015 <br />695.00 <br />186.22 <br />26.05 <br />907.27 <br />Total <br />$907.27 <br />Jul. 17. 2015 2:26PM NE Secretary _4 State. — UCC <br />Nebraska Depertrnenl 01 <br />REVENUE <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 Ilen or continuation statement. <br />Nebraska ID Number <br />94157898 <br />Oen Sera Number <br />11554564 <br />Date of Lien <br />07/15/2015 <br />sign <br />here <br />Business Name and Location Address <br />I certify that the Ne <br />and that the Taxpayer <br />the Sta ' interest in <br />Lien Filed With: <br />(xi Register of Deeds County Clerk <br />Lien Type: <br />© ori D Continuation Corrected <br />re0 1 ...e ire <br />Author ^ dSignature <br />2015048n <br />Notice of State Tax Lien <br />Revenue Anent <br />PLEASE DO NOT WRITE IN THIS SPACE <br />Federal ID Nurnber <br />Social Security Number <br />XXX -XX -4833 <br />5pouee'e Social Security Number <br />county <br />HALL <br />Taxpaxrer Name and Mailing Address <br />EFRAIN HERNANDEZ GONZALEZ <br />414 N ELM ST APT 1 <br />GRAND ISLAND NE 68801 <br />N'. 1848 E. 2 <br />NE Sec of Nsaae Jonn .4 Gat_ - - ;IL <br />1 � <br />0915757916 -3 PQS• <br />GONZALEZ EFRAIN HERNANDEZ <br />Flied: 07/17/2015 01:09 PM <br />Ica Department of Revenue has oomptfed with the WE of the Slate of Nebraska in determining the amount shown to be due, <br />Called to pay the amount due after demand. This Notice of State Tax Lien is an effeclve lien and serves to opnIInue the prtodly of <br />affected properly of the taxpayer. <br />07/15/2015 (4;02)471 -6043 <br />Trde Date Phone Number <br />Revenue Supervisor 07/15/2015 <br />Tkle • gate <br />4. P74 Rev. 8-2015 aupemetlee 4-949.1974 flew. 2-2002 <br />