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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 />2014 <br />05/19/2015 <br />• 410.00 <br />24.35 <br />19.15 <br />453.50 <br />• <br />Total <br />$453.50 <br />Se:, 12. 2016 3:15F'M NE Se .r tart' of State — UCC <br />PLEASE RETURN TO: <br />NEBRASKA DEPT OF REVENUE <br />PO BOX 94609 <br />LINCOLN NE 68509 -4609 <br />Nebraska 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 property iocated <br />to the county and rights to property owned by the taxpayer or <br />acquired before the expiration of this lien.Thls Ilen will expire and <br />become unenforceable 10 years after the date of recording If no <br />continuation statement is recorded an or prior to the expiration of <br />the previous lien or continuation statement. <br />Nebraska ID Number <br />38178613 <br />Lien Serial Number <br />11676928. <br />Date of Llen <br />09/06/2016 <br />sign <br />here <br />Authorized <br />ure <br />Notice of State Tax Lien <br />Lien flied WIth: <br />E Register of Deeds ❑ County Cleric <br />Business Name and Location Address <br />h:= <br />Ice <br />and that <br />the. <br />Depa <br />led to p <br />affecle <br />201605980 <br />PLEASE DO NOT WRITE IN THIS SPACE <br />Federal ID Number <br />Social Security Number <br />XXX -XX -6354 <br />ROSA M ZAVALA- GARCIA <br />117 VOSS RD <br />GRAND ISLAND NE 68801 <br />Revenue Agent <br />o. 7954 <br />NE Sac of Eta *. Jnhn A Gale - IJ CC STL <br />Lien Type: County <br />X❑ Original ❑ Conitrwallon ❑ Corrected HALL <br />Taxpayer Name and Mailing Address <br />9916779641 -8 Pea 1 <br />ZAVALA — GARCIA ROSR 0 <br />Filed: 09/12/2016 09 :21 AM <br />Spouse's Social Security Number <br />of Revenue has complied with the laws of the State of Nebraska In determining the amount shown to be due, <br />amount due after demand, This Notice of Stale Tax Lien is an effective lien and serves to continue the priority of <br />Perly of the taxpayer. • <br />09/06/2016 (3081632 -1210 <br />Tide . Dale Phone Number <br />Revenue Supervisor 09/06/2016 <br />Tide Date <br />4- 494 -1971 Rev 5 Superee0ea 4949 -1974 Rev, 2 - 2002 <br />