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Mar, 6. 2018 3:04FM NE Secretary of State <br />Nebraska Department 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 Hen or continuation statement. <br />Nebraska ID Number <br />47157798 <br />Lien Serial Number <br />Uen Flied Widt <br />60 Register 01 Deeds <br />11802883 <br />Dale o1 Lien Lien type: <br />March 01, 2018 ® original <br />Business Name and Location Address _ <br />I certllythat the Nebraska Deparlme <br />and that Ole taxpayer rise ,:. ed to pay <br />the Siate's interest in t -. <br />Sign <br />here <br />Notice of State Tax Lien <br />Courtly Clerk <br />0continuatlan <br />Title <br />PLEASE DO NOT WRITE 144 THIS SPACE <br />Federal D Number <br />Social Security Numbe+ <br />XXX-XX-8643 <br />PLEASE RETURN TO: <br />NEBRASKA DEPT OF REVENUE <br />PO BOX 94609 <br />LINCOLN NE 68509 -4609 <br />p Corrected <br />NE Soo of Stele John A Sole - UGC ST <br />20''8 3 122 <br />9918607199 -8 P9s <br />ADRIAN ARELLANO ESTELLA F <br />Flltd: 03/06/2016 10:13 An <br />Spouses Social Security Number <br />County <br />HALL <br />Taxpayer Name and Mailing Address <br />ESTELLA F ADRIAN ARELLANO <br />1109 W ANNA STREET <br />GRAND ISLAND NE 68801 <br />Tax Program <br />Individual <br />• Individual • <br />- Individual <br />Tax Period <br />2013 <br />2014 <br />2015 <br />Date of - <br />Assessment <br />07/16/2017 <br />07/16/2017 <br />07/16/2017 <br />Tax <br />$11,391.00 <br />$19,923.08 <br />813,054.00 <br />Penalty <br />$3,052.28 <br />$5,231.03 <br />$3,498.88 <br />Interest <br />$1,325.72 <br />$1,721.03 <br />$734.95 <br />Costs <br />Total Due <br />15,769.00 <br />26,875.14 <br />17,287.83 <br />EL <br />Total $59,931.87 <br />shown krbe due, <br />has demand the laws of the <br />of Stet State ax Lien is iss an effective hen and serves f amount ntinue the priority of <br />Revenue Agent 03/01/2018 (308)632 -1206 <br />Tide Date Phone Number <br />Revenue Supervisor 03/01/2018 <br />Dale <br />4- 474.1874 Rev. 9-2013 Supersedes 4440 -1874 Pei. 2-2002 <br />