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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 />Individual <br />2014 <br />08/26/2016 _ <br />$640 -00 <br />$32.00 <br />$49.24 <br />721.24 <br />Individual <br />2015 <br />05/08/2017 <br />$1,089.00 <br />$54.45 <br />$51.02 <br />1,194.47 <br />Total <br />$1,915.71 <br />This Notice of State Tax Lien is issued by the Nebraska <br />Department of Revenue for unpaid taxes administered by theTax <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 WRITE IN THIS SPACE <br />Nebraska ID Number <br />46728074 <br />Federal ID Number <br />uen Serial Number <br />11796909 <br />Lien Filed With: <br />111 Register of Deeds County Clerk <br />Social Security Number <br />XXX -XX -6796 <br />Spouse's Social Security Number , <br />Date of Lien <br />November 06, 2017 <br />Lich Type: <br />J Original DContinuation © Corrcclod <br />County <br />HALL <br />Nov. $. 2017 3:36PM NE Secretary of State — UCC <br />Nebraska °apartment of <br />REVENUE <br />Business Name and Location Address <br />2017076 '1 <br />Notice of State Tax Lien <br />NO sec <br />a1 !<4.i. Jot,, 9 G.I. - <br />No. 2566 P. 2 <br />9917801379 -2 <br />LUCAS COR JERONIMO <br />Flled: 11/00/2017 10:44 AM <br />Taxpayer Name and Mailing Address <br />JERONIMO LUCAS COR <br />215 E 7TH STREET <br />GRAND ISLAND NE 68801 <br />A thorned Signature Title Date <br />UGC STL <br />Pas <br />I certify That the Nebraska Department of Revenue has complied with the laws 01 the State of Nebraska In determining the amount Shown to be due. <br />and that the taxpayer has failed b pay the amount due after demand -This Notice of State Tax Lien Is an effective lien and serves to continue the priority of <br />the •- e's Interest In the aryecled property of the taxpayer. <br />R Agent 11/06/2017 (402)471 -5713 <br />Title Date Phone Number <br />Revenue Supervisor 11/06/2017 <br />4-494-1974 Rev. 9 Supersedes 4 -949 -1074 Rev. 2-200 <br />