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Tex program Tax Period Assessment Tax Penalty Interest Costs Total Due Individual 2014 01/11/2016 257.00 12.86 15.08 284.93 Total S $284.93 Apr. 4. 2517 3: 21 FM No. 3751 PLEASE RETURN TO: NEBRASKA DEPT OF REVENUE PO BOX 94609 LINCOLN NE 68509 -4609 Nebraska Department or REVENUE This Notice of State Tax Lien Is Issued by the Nebraska Department of Revenue for unpaid taxes administered by the Tax Commissioner. Taxes, including penalties, interest, and costs, which are shown below, are due from the taxpayer and remain unpaid after demend.These taxes are a lien for all property located In the county and rights to property owned by the taxpayer or acquired before the expiration of this lien,Thts 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 lien or continuation statement. Nebraska ID Number 93681518 Lien Serial Number /1786074 Date of Lien 03129/2017 sign here Notice of State Tax Lien Lien Filed Whh: Register of Deeds [3 County Clerk Title PLEASE DO NOT WRITE IN THIS SPACE Federal ID Number Social Security Number XXX -XX -9447 . MAIKEL ACUNA SILVEIRA 916 S EDDY ST GRAND ISLAND NE 68801 Revenue Agent Title Revenue Supervisor NE See of State John A ee - UCC ST County HALL 20170210 9917789795 -3 Pg, SILVEIRA MAIKEL ACUNA Filed: 04/04/2017 01409 PM Lien Type; IN Original ❑ Continuation [3 Corrected Business Name and Location Address Ta payer Name and Mailing Address j Spouse's Social Security Number partmenl of Revenue has complied with the laws of the Slate of Nebraska to deterntlning the amount shown to be due, a amount due after demand. This Notice of Slate Tax Llen Is an effective lien and serves to continue the priority of eled property of the taxpayer. 03/29/2017 (308)632-1210 Date Phone Number 03/29/2017 Dale 4.04.1974 ReV. B -2019 Supersedes 4949 -1971 Rev.2.2042