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Jun, 12. 2017 3:17PM. NE Secretary of State — UCC <br />oa <br />Nebraska Deportment 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 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 />94483752 <br />Uen Serial Number <br />11789181 <br />Date of Lien <br />06/07/2017 <br />Tax <br />Program <br />Individual <br />sign <br />here <br />Business Name and Location Address <br />Tax Period <br />2015 <br />P Ignal <br />Authorii2ed Slgnalure <br />Lien Filed With: <br />® Register o1 Deeds D County Clerk <br />Pala of <br />Assaeomont <br />11/03/2016 <br />Tax <br />243.00 <br />20170392 <br />Notice of State Tax Lien <br />Federal D Number <br />Social Security Number <br />XXX -XX -2577 <br />Lien Type. <br />Original ❑ Continuation ❑ correcled <br />Penalty <br />12.15 <br />Interest <br />8.34 <br />Soo of SIa4s Jahn A 0.11 <br />PLEASE DO NOT WRITE IN THIS SPACE <br />BENJAMIN ZAMORA RAMIREZ <br />625 SEMINAR DR APT 215 <br />HOUSTON TX 77060 <br />.No. 1029. P, 2/2_. <br />Spouse's Social Security Number <br />County <br />HALL <br />Taxpayer Name and Mailing Address <br />Total <br />Corals Total Due <br />1 certify that the Nebraska Department of Revenue has complied with the laws of the Stale of Nebraska In determining the amount shown to be due, <br />4 lha1 the taxpayer has failed to pay the amount due after demand, This Notice of State Tax Uen Is an effective lien and selves to continua the priority of <br />he 81 = te's Interest in the ale roperty of Ire taxpayer. <br />1 <br />�t >f 1 1L • _tW10' <br />- UCC STL <br />9917793313 -3 Po s: 1 <br />RAMIREZ 9ENJAMIN ZAMORA <br />Filed; 0611212017 11:04 AM <br />263.49 <br />$263.49 <br />Revenue Agent 06/07/2017 (402)411.5928 <br />Title Date Phone Number <br />Revenue Supervisor 06/07/2017 <br />Tine Date <br />4 Rey 94813 Supersedes 4 - 964 Rev. 2 -2092 <br />