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Program Tax Period Assaess of Tax Penalty Interest Costa Total Due Individual 2012 11/09/2014 526.00 26.30 53.13 605,43 Total $605.43 Aug, 30. 2016 3:26FM NE Secretary c tSf to — UCC Nehrasko Department of REVENUE This Notice of State Tax Lien is issued by the Nebraska Department of Revenue for unpaid taxes administered by the Tax Commission, Taxes, Including penalties, interest, and costs, which are shown below, are due from the taxpayer and remain unpaid after demand.These taxes are a lien tor all property located in the county and rights to property awned by the taxpayer or acquired before the expiration of this Iien.This Lien will expire and become unenforceable 10 years after the date of recording if no continuation statement is recorded on or prior to the expiration of the previous Ilen or continuation statement, Nebraska ID Number 99857197 Lien Serial Number 11676538 Date of Lien uen Type: 08/26/2016 OK1 original ❑ Conttualion Business Name and Location Address Lien Pied WM: Register of feeds County Clerk 2oi6o6654 Notice of State Tax Lien PLEASE DO NOT WRITE INTJIIS SPACE Federal ID Number Social Security Number XXX-XX-5226 HENRY A CALLEJAS 819W14THST GRAND ISLAND NE 68801 V c . 7 8 8 7 P . 2 / 1 2 PH Se=er 54.4.1 5� °� Jain R °,. -- Pot 1 99167792 CALLEJAS ntso ?016 09.56 AM Spouse's Social Security Number County ❑ corrected HALL Taxpayer Name and Mailln Address I cenlly that the Nebraska Department of Revenue has complied with the Iawa or the State of Nebraska In determining the amount shown to be due, end that the taxpayer has Wad to pay the amount due eller demand. This Notice of Stale Tax Lien Is an effective hen and aelvee to continue Me priority of State's interest in the affected property al the taxpayer. Revenue Agent 08/26/2018 (402)471-5712 Title Date Phone Number Revenue Supervisor 08 /2612016 Title Date 44941974 Pw. 42013 Sireerseeee d- 94tr.1974 Flo% 2.2t1e2