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Tax Program <br />Tel Period <br />Assessment <br />Tex <br />Penally <br />Interest <br />Costa <br />Total Due <br />Individual <br />2013 <br />05108/2014 <br />149.96 <br />122.05 <br />29.54 <br />301.56 <br />individual <br />2014 <br />04/22/2015 <br />1,253.00 <br />77.65 <br />37,59 <br />1,368.24 <br />. Total <br />$1,669.79 <br />Apr. 18. 2016 4:05PM NE Secretary of State — UCC <br />Nebrask e- De pa rrm en t o f <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 area lien for all property located <br />In the county and rights to property owned by the taxpayer or <br />acquired before the expiration of thls 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 />45489971 <br />Lien Serial Number <br />11668962 <br />Sign <br />here <br />201602322 <br />Notice of State Tax Lien <br />Lien Fled With: <br />® Register or Deeds ['County Clerk <br />Date of Lien Lien Type: <br />04114/2016 ® Ong °Continuation <br />Business Name and Location Address <br />Au t +dyed Signature <br />Federal D Number <br />Social Security Number <br />XXX -XX -0169 <br />❑ corrected <br />IVAN V RUIZ GUADERRANIA <br />1121 W 7TH ST <br />. GRAND ISLAND NE 68801 <br />I certify that the Nebraska Department of Revenue has complied with the laws of fire Stale of Nebraska In determining the amount shown to be due, <br />and thal the taxpayer has ailed to pay the amount due after demand. This Notice of State Tax Lien is an effective hen and serves to continue the priority of <br />the Si •:t interes in + affected property of the taxpayer. <br />Revenue Agent <br />PLEASE DO NOT WRITE INTHIS SPACE <br />- row <br />Revenue Supervisor <br />Tide <br />E sc. of St.tc aorrt+ .. fide - �TL <br />9916772266 -5 PBS: 1' <br />RUIZ GUADERRRMR IVAN V <br />Filed: 04/18/2016 01:12 PM <br />Spouse's Socfel Security Number <br />County <br />HALL <br />Taxpayer Name and Mailing Address <br />No. 6142 P. 2 <br />04/14/2016 (402)471 -6043 <br />Date Phone Number <br />04/14/2016 <br />Dale <br />44941974 Rev. 1-2913 Supersedes 4-949-1974 Rex 2.2002 <br />