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Tax Program <br />Tax Period <br />Date of <br />Assessment <br />Tax <br />Penalty <br />Interest <br />Costs <br />Total Due <br />Sales <br />04/01/2014 - 09/30/2014 <br />02/02/2015 <br />.00 <br />' .00 <br />1.03 <br />.00 <br />1.03 <br />Sales <br />01/01/2015 - 12/31/2015 <br />06/04/2016 <br />160.00 <br />116.00 <br />7.84 <br />.00 <br />283.84 <br />Total <br />284.87 <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 />PLEASE DO NOT W RITE IN THIS SPACE <br />Nebraska ID Number <br />11787171 <br />Federal ID Number <br />Lien Serial Number <br />11786920 <br />Lien Flied With: <br />Social Security Number <br />XXX -XX -4750 <br />Spouse's Social Security Number <br />Pi Register of Deeds [] County Clerk <br />Date of Lien <br />April 26, 2017 <br />Lien Type: <br />[] Corrected <br />County <br />HALI1 <br />IN Original NI Continuation <br />Nebraska DepartmenT 01 <br />REVENUE <br />ay. 9. 2017 2:57FM NE S .retary of 'State — UCC <br />sign <br />here <br />Business Name and Location Address <br />Notice of State Tax Lien <br />Tax <br />2 <br />INISelaillalljahln a Gala - 1 17 <br />99 17 7 9188® -9 <br />RAMIREZ —LEMUS ELID P9s 1 <br />Filed; 05/09/2017 10146 PM <br />a er Name and relailin <br />ELIO RAMIREZ -LEMUS <br />901 W 17TH ST <br />GRAND ISLAND NE 68801 <br />Address <br />I certify net the Nebraska Department of Revenue has complied with the laws of the Slate of Nebraska in determining the amount shown to be due, <br />and that the taxpayer has tatted to pay the amount due eher demand. This Notice of Slate Tax Lien is an effective lien and serves to continue the priority of <br />the Stet'- 'merest in the etfected p ' arty • I the taxpayer. <br />Revenue Agent 05/01/2017 402 -471 -6067 <br />Title Date Phone Number <br />Revenue Senior Agent 54 / 7 <br />Title . Dale <br />4- 494.1974 her 8-2013 Supersedes 4-949-1974 Rev. 2 -2002 <br />S`R/ <br />