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Tax Program <br />Tax Period <br />bate of <br />Assessment <br />Tax <br />Penalty <br />Interest <br />Costs <br />Total Due <br />Individual <br />2014 <br />01/11/2016 <br />$922.00 <br />$46.10 <br />$75.48 <br />I Corrected <br />1,043.58 <br />Total <br />$1,043 -58 <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 WRITE IN THIS SPACE <br />Nebraska ID Numbct <br />94706646 ' <br />Federal ID Number <br />Lien Serial Number <br />11899325 <br />Llen Filed Wilhtr <br />NJ Register or Deeds 0 County Clerk <br />Social Security Number <br />)0(X_XX -2052 <br />Spouse's Socha! Security Number <br />Dale of Lien <br />January 05, 2018 <br />Lien Type: <br />County <br />HALL <br />® original I Continuation <br />I Corrected <br />Jan. 9. 2516 3:57FM NE Secretary of State — UCC <br />0111 <br />Nebraska Department of <br />REVENUE <br />sign <br />here <br />IA- All A <br />Business Name and Location Address <br />Pr= = rer's Signature <br />thorned Signature <br />20180018 <br />Notice of State Tax Lien <br />Revenue Agent <br />Title <br />Revenue Supervisor <br />Title <br />Na sae of Sie4e Jth <br />No. 3221 F. 2 <br />9918894176 -7 Pgs 1 <br />JPRD /NEZ HERNANDEZ YUN!OR 0 <br />Filed: 01/09/2018 08:60 An <br />Date <br />A l <br />Taxpayer Name and Mailing Address <br />YUNIOR 0 JARDINEZ HERNANDEZ <br />211 N GRACE ST APT 2 <br />GRAND ISLAND NE 68801 <br />ucc s'L <br />I certify that the Nebraska Department of Revenue has compiled with the laws of the State of Nebraska in determining IN amount shown to be due, <br />and that the taxpayer has failed to pay the amount due after demand. This Nonce of State Tax Lien is an effective lien and serves to continue the priority of <br />the Slate's interest in the affected property of the taxpayer. <br />01105/2018 5402)471 5712 <br />Phone Number <br />01/05/2018 <br />Date <br />dd &4 - 1074 Rev. 0 -2013 Supersedes 4-949-1970 Rev. 2-20 <br />