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Tex Program <br />Tax Period <br />Assessment Date <br />TeX <br />Penalty <br />Interest <br />Costs <br />Total Due <br />Individual <br />2009 <br />06/1812013 <br />5,545.21 <br />277.26 <br />1,178.47 <br />7,000.94 <br />Individual <br />2010 <br />0611812013 <br />1,411.00 <br />70.55 <br />229.31 <br />1,710.86 <br />Individual <br />2011 <br />06/18/2013 <br />4,994.67 <br />249.73 <br />' 561.32 <br />5,805.72 <br />Total <br />$14,517.52 <br />!u1.2H. 2015 3:04PM <br />Nob( eske Department of <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 prevlous lien or continuation statement. <br />Nebraska ID Number <br />42782341 <br />Lien Serial Number <br />11555222 <br />Date of Lien <br />07/2312015 <br />Uen Red With: <br />Register of Deeds . Count Clerk <br />Den Type: <br />tig 040a1 ❑ Continuation <br />Business Name and Location Address <br />2015+5104 <br />Notice of State Tax Lien <br />PLEASE b0 NOT WRITE IN THIS SPACE <br />federal ID Number <br />Soda! Security Number <br />XXX -XX -9232 <br />❑ corrected <br />RAMON VERJAN VELAZQUEZ <br />2211 COCHIN ST <br />GRAND ISLAND NE 68801 <br />No. 2522 F. 2 <br />N4 A.o of 14.e. John A art - UCC LTL <br />9915758567 -3 Pas: <br />VELAZQUEZ RAMON VERJAN <br />Filed: 07/28/2015 02;31 p1R <br />PLEASE RETURN TO: <br />NEBRASKA DEPT OP REVENUE <br />PO BOX 94609 <br />LINCOLN NE 68509 -4609 <br />Spouse's Social Security Number <br />County <br />HALL <br />Taxpayer Name and Mailing Address <br />I certify that the Nebraska Department of Revenue has complied with the taws of the Slate of Nebraska in determining the amount shown to De due, <br />and that the taxpayer has tatted to pay the'amounl due alter demend.This Notice of State Tax Lien Is in effective lien and serves to continue the priion'ty of <br />the State's interest in the affeoled operty of the Taxpayer. <br />07123/2015 <br />Data <br />(308)632 -1203 <br />Phone Number <br />07/23/2015 <br />Revenue Agent <br />rue <br />Revenue Supervisor <br />Title Date <br />4 -494 -1974 Rev, 8 -2013 9upersecle5 4'9 -1974 Rev. 2.2002 <br />