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Tax <br />Program <br />Period <br />Dale of <br />Assessment <br />Tex <br />Penalty <br />Interest <br />Costa <br />Total Due <br />Individual <br />2015 <br />12/04/2016 <br />665.00 <br />33.25 <br />21.76 <br />720.01 <br />Total <br />$720.01 <br />_May. 24. 2017- 3:45FM. ..NE Secretary of State — UCC <br />Habra Ka Dep2rrmenT or <br />REVENUE <br />This Notice of State Tax Llen is issued by the Nebraska <br />Department of Revenue for unpaid taxes administered by thelax <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 Ilen for all property located <br />In the county and rights to property owned by the taxpayer or <br />acquired before the expiration of this IIen.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 />93172125 <br />Llen Serial Number <br />11788106 <br />Date of Lien <br />0511712017 <br />Lien Filed With: <br />Notice of State Tax Lien <br />Register o1 Deeds ❑ County Clerk <br />Business Name and Location Address <br />201703458 <br />PLEASE DO NOT WRITE IN THIS SPACE <br />Federal ID Number <br />Social Security Number <br />XXX -XX -1172 <br />Lien Type: <br />Q of g inal ❑ ConllnuaAon Ca traded <br />AMAURI GOMEZ NUNEZ <br />310 W 7TH ST APT 3 <br />GRAND ISLAND NE 68801 <br />NEI Lp <br />Nc. 0850 P. 2 <br />John R sale - YCC CTL <br />Pas: <br />9917792470 -4 <br />cnMEZ NUNEZ RMRURI <br />Filed: 05/24/2017 10:39 AM <br />Spouse's Social Security Number <br />county <br />HALL <br />Taxpayer Name and Mailing Address <br />certify that the Nebraska Department of Revenue has compiled o h the laws el the Stale of Neb1aaka In detemdning the amount Shown 10 be due. <br />nd that the taxpayer r : failed to pay the amount due after demand. This Notice of Stale Tax Llen Is an effective lien and serves to continue the priority of <br />Slate's Inter alleoted properly 01 the taxpayer_ <br />evenue Agent 05/17/2017 (402)471 -5731 <br />Title Dale Phone Number <br />Revenue Supervisor 05117/2017 <br />Date <br />4-49`1 Aev. B-2013 Supersede& 4840-1a74 ReV. 2 -200 <br />A__ <br />