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Tax Program <br />Tax Period <br />Assessment <br />Tax <br />Penalty <br />Interest <br />Costs <br />Total Due <br />Individual <br />2010 <br />04/05/2014 <br />311.00 <br />15.56 <br />59.77 <br />.386.32 <br />Total <br />$386.32 <br />Jul. 20. 21)16 3:38F'M .NE Secretary if State — UCC• <br />Nebraska DepaKhler5 Of <br />REVENUE <br />Notice of State Tax Lien <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 Ilen for all property located <br />in the county and rights to property owned by the taxpayer or <br />acquired before the expiration of this llen.This lien will expire and <br />become unenforceable 10 years after the date of recording it 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 />46966331 <br />Lien Serial Number <br />11674515 <br />Date 01 Lien <br />07/18/2016 <br />sign <br />here <br />Lien Filed With' <br />© Reglsler of Deeds ° County Clerk <br />Business Name and Location Address <br />Au orized Signature <br />PLE=ASE DO NOT WHITE INTNIS SPACE <br />Federal ID Number <br />Social Security Number <br />XXX -XX -3733 <br />Lien Type: <br />( Original []Continuation ❑ Correctod <br />JULIO A RIVERA FONTANEZ <br />518 E CAPITAL AVE LOT 16 <br />GRAND ISLAND NE 68801 <br />N sec or i1a4e J hn S Gale - ACC STL <br />County <br />HALL <br />Taxpayer Name and Mailing Address <br />201 <br />Spouse's Social Security Number <br />n1 of Raven complied with the laws of the State of Nebraska In determining the amount shown to be due, <br />e amount d et demand. This Notice of State Tax Lien Is an effective lien and serves to continue the priority of <br />nyol the t: -. r. <br />9910777219 -1 Pas: <br />RIVERA FONTANEZ JULIO A <br />Filed: 07/20/2015 11 17 AM <br />nay that the <br />the taxp <br />" 's Inter <br />Prepare.= Signature <br />eke D <br />fall <br />all e <br />Revenue Agent <br />Title <br />Revenue Supervisor <br />Title <br />Dale <br />07/16/2016 (402)471 -5731 <br />Phone Number <br />07/18/2016 <br />Date <br />4494 -1974 Rev. 0-2015 Supersedes 4-949 -1974 Rev. 2-2002 <br />