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Tex <br />prygrarn <br />Tax Period <br />Date of <br />Assessment <br />Tax <br />Penalty <br />Interest <br />Costs <br />Total Due <br />Individual <br />2014 <br />03/2512016 <br />956.00 <br />47.80 <br />43.61 <br />1,047.41 <br />Individual <br />2015 <br />07/0512016 <br />542.00 <br />36.87 <br />8.42 <br />687.29 <br />Total <br />$1,834,70 <br />Oct, 25. 2016 3:23FM NE Secretary of State — UCC <br />Nebraako 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 located <br />in the county and rights to property owned by the taxpayer or <br />acquired before the expiration of this lien.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 />95412131 <br />Lien Serial Number <br />11679320 <br />Dale of Lien <br />10/21/2016 <br />sign <br />here <br />Au1 <br />Lien Flied With: <br />® Reglaler of Deady [] County Clerk <br />Lien Type' <br />Original D Continuation <br />Business Name and Location Address <br />rized Signature <br />Notice of State Tax Lien <br />PLEASE DO NOT WRITE IN THIS SPACE <br />Federal ID Number <br />Social Security Number <br />XXX -XX -5122 <br />Corrected <br />MARTA RALIOS- ZACARIAS <br />1110 W 8TH <br />GRAND ISLAND NE 68801 <br />Revenue Agent <br />Title <br />Revenue Supervisor <br />County <br />HALL <br />Taxpayer Name and Mailing Address <br />201017165 <br />NE Sec a1 VW. Jnl.n A Gala - ACC am <br />9916781753 -9 Pee: 1 <br />RALIOS— ZACARIAS MARTA <br />Filed: 10/25/2010 09:15 AM <br />Spouse a Soda! Security Number <br />t certify that the Nebraska Department of Revenue has complied with the laws of the Slate of Nebraska 61 determining the amount shown to be due, <br />and that the taxpayer has fa to pay the amount due after demand .TMs Notice of State Tax Lien Is an effective lien and serves to continue the priority of <br />the ; interest • the . ted property of the taxpayer <br />10/21/2016 (4.02)471 -6043 <br />Dale Phone Number <br />10/21/2016 <br />Title Dale <br />44941974 Re404013 Supereedea 4449-1974 Rev. 24002 <br />