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201604357
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7/12/2016 4:11:57 PM
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7/12/2016 4:11:57 PM
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DEEDS
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201604357
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Tax <br />Program <br />Tax Period <br />Date of <br />Assessment <br />Tax <br />Penalty <br />Interest <br />Costs <br />Total Due <br />Individual <br />2012 <br />12/22/2015 <br />1,975.00 <br />98.76 <br />191.22 <br />2,264.97 <br />Total <br />$2,264.97 <br />Jul. 12. 2116 3:37FM NE Secretary of State — UCC <br />201604357 <br />N Departroef1 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 previous lien or continuation statement. <br />Nebraska ID Number <br />33184860 <br />Lien Serial Number <br />11674008 <br />Date of Lien <br />07/0612016 <br />sign <br />here <br />Lien Filed With: <br />® Register of Deeds Courtly Clerk <br />Lien Type: <br />Original <br />Notice of State Tax Lien <br />Federal ID Number <br />Social Security Number <br />)00C-XX -1224 <br />Corainualion ❑Corrected <br />PLEASE DO NOT WRITE INTHIS SPACE <br />Business Name and Location Address <br />JULIE BARRIENTEZ <br />PO BOX 208 <br />DONIPHAN NE 68832 -0208 <br />1 certify mat the Nebraska Department al Revenue has compiled with the taws of the Stale of Nebraska In determining the amount shown to be due, <br />and the/ the taxpayer has fatted w pay the amount due after demand. This Notice of Stale Tex Lien is an effective Ilen and serves to continue the priority of <br />the Slate's interest in the affect = property of the taxpayer. <br />Revenue Agent <br />TIOe <br />Revenue Supervisor <br />Tit le <br />0.719 <br />NE Inc of S alp John a 6.1. - <br />Al 1H <br />9918776809 -1 Pea <br />BRRRIENTEZ JULIE <br />Filed: 07/12/2016 01:40 PM <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 />UGC iTL <br />07/06/2016 (308)632 -1203 <br />Dale Phone Number <br />0710612016 <br />Dale <br />44941971 Rev. 8.2013 supersede& 4 Rev, 2 - 2002 <br />9 <br />
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