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Tax Program Tax Period Assessment Tax Penalty Interest Costs Total Due Individual 2011 03123/2015 506.00 25.30 85.69 616.99 Total $616.99 .un.21. 2017 3:21FV1 NE ecrutary of State — UCC Nu. 1125 F. 2/3 Nebracka Departrr nr of REVENUE This Notice of State Tax Lien is issued by the Nebraska Department of Revenue tor 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 demand.These taxes area lien for all property located in the county and rights to property owned by the taxpayer or acquired before the expiration of this ilen_Thls 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 Iten or continuation statement. Nebraska ID Number 46423443 Lien Serial Number 11769666 Dale of Lien 06/15/2017 Business Name and Location Address Notice of State Tax Lien Lien Filed With: Fegfster of Coeds fl Courtly Clerk 201704145 Lisn Type: ® Original Continuation LJ Corrected Revenue Agent Tide PLEASE DO NOT WRITE 1NTHIS SPACE Federal ID Number Social Security Number XXX -XX- 4511 MANUEAL MEJIA 1223 HUNTER DR TEXAS CITY TX 71590 Title Revenue Supervisor NE Sae si.ba ]chn A G.ta - UCC StL 9917793883 -0 Pets; 1 Ft led M ; 70;05 RM Spouse's Social Security Number County HALL Taxpayer Name and Mailing Address I certify that 1he Nebraska Deparb1re01 of Revenue ttas Compried with the laws of the Slate of Nebraska in determining the amount shown In be due. and that the taxpayer has faded to pay the amount due after demand. This Notice of Stele Tax Lien is an eflective lien and Serves 10 Continue the priority of the S1ate'e Interest In the affected property of the taxpayer. 06/15/2017 (402)471 -5712 Date Phone Number 06/1512017 Dale 4404 -1974 Rev, 8-2019 Supersedes 4- 949 -1974 Rev. 2.2002