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Program <br />Tax Period <br />Assessment <br />Tax <br />Penalty <br />Interest <br />Coats <br />Total Due <br />Individual <br />2010 <br />05/13/2013 <br />346.00 <br />17.30 <br />80.55 <br />423.85 <br />Total <br />$423.85 <br />Dec, 28. 2015 0:51FM NE Secretary of state — UCC. No. 4295, P. 2 <br />.. 111111111111111111111 <br />9915765753 -0• pe: 1 <br />PEREZ CRUZ JUAN A <br />Filed: 12f7B1201G 01.57 Pri • <br />Nebroake 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 propertylocated <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 data 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 />96588691 <br />Lien Serial Number <br />11562848 <br />Date of Lien lion Type: <br />12/22/2015 © Original <br />Business Name and Location Address <br />sign <br />here p P <br />Lien Filed With: <br />IN Register of Deeds 0 County Clerk <br />Authorized Sign <br />Notice of State Tax Lien <br />0 Continuation <br />Title <br />PLEASE DO NOT WRITE INTHIS SPACE <br />Federal ID Number <br />Social Security Number <br />XXX -XX -8953 <br />Revenue Agent <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 />❑ corrected HALL <br />Taxpayer Name and Melling Address <br />JUAN A PEREZ CRUZ <br />229 S SYCAMORE STREET <br />GRAND ISLAND NE 68801 <br />I certify that the Nebraska Department of Revenue has complied with the laws of the Stale of Nebraska In determining the amount shown lobe due, <br />and that the taxpayer has failed to pay the amount due alter demand. This Norma of Stale Tax Lien is an effeoLtie Gen and serves to continue the priority of <br />l re State% interest In the e <br />Title <br />Revenue Supervisor <br />12/22/2015 (308)632 -1206 <br />Dale Phone Number <br />12/22/2015 <br />Date <br />4494.1924 Rev. 8 -2013 Supersedes 4.919 -1971 Rev. 2 - 2002 <br />