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• Oct. 26. 2015 2 44P NE Secretary of State — UCC <br />Nebraska 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 Ilen.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 />Nebraska ID Number <br />98441248 <br />Lien Serial Number <br />11559924 <br />Date of Lien <br />10/22/2015 • <br />Uen Hied With: <br />® Register of Deeds 0 County Clerk <br />uen Type: <br />® Original <br />Business Name and Location Address <br />Tax <br />Program <br />Individual <br />Sign <br />here <br />Tax Period <br />2011 <br />Authorized Signature <br />Notice of State Tax Lien <br />Date of <br />Assessment <br />02/08/2014 <br />Continuation <br />Tax <br />192.27 <br />20150733/ <br />PLEASE DO NOT WRITE IN THIS SPACE <br />Federal ID Number <br />Social Security Number <br />XXX XX -5252 <br />Q Corrected <br />ANASTACIO T MARTINEZ JR <br />706 ORLEANS DR APT 4 <br />GRAND ISLAND NE 68B01 -3411 <br />Penalty <br />9.61 <br />certify that the Nebraska Department of Revenue has complied with the laws of the Stele of webieska in delermrnng the amount Shown to be due. <br />and that the taxpayer has fatted to pay the amount due after demand. This Notice el Slate Tax Lien is an effective lien and serves (o continue the prority of <br />the State's interest In the of lh yer, <br />Revenue Agent <br />Title <br />PLEASE RETURN TO; <br />NEBRASKA DEPT OF 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 />Interest <br />23.05 <br />The <br />tlIgS/O-LB. rinlif f 4t <br />NS S.c of 5.$. c John A bole - 1106 ST <br />5915752850 -0 P9 a: 1 <br />IIARTINEZ ANr1STACIO T JR <br />Filed: 10/26/2015 91:31 PM <br />Cas <br />Total <br />10/22/2015 <br />Dale <br />No. 3296 P. 2 <br />Total Due <br />224.93 <br />$224.93 <br />(308)632 -1206 <br />Phone Number <br />10/22/2015 <br />Dale <br />4- 494-1974 Rev. 0-2013 S,lpereeoes 4949 -1974 Pete. 2-2002 <br />