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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 />2016 <br />06/23/2017 <br />$730.00 <br />$36.50 <br />$19.50 <br />786.00 <br />Total <br />$786.00 <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 />PLEASE DO NOT WRITE IN THIS SPACE <br />. <br />Nebraska ID Number <br />95871942 <br />Federal ID Number <br />Lien Serial Number <br />11803061 <br />Lien Filed With: <br />Social Security Number - <br />XXX- XX.7355 <br />^,spouse's Social Security Number <br />4 Register of Deeds U County Clerk <br />Date of Lien <br />March 06, 2018 <br />laen Type: <br />❑Corrected <br />County <br />HALL <br />Li original II Continuation <br />Mar. 7. 2013 4:17PM NE Secretary of State — UCC <br />• <br />Nebraska nspartment of <br />REVENUE <br />sign <br />here <br />Business Name and Location Address <br />a Signalu <br />201801411 <br />Notice of State Tax Lien <br />N! <br />S.c of 5l.*• John A Cal. - uCu STL <br />1 11 <br />99188072Se -2 P ea! <br />TELLEZ HERRERA JOAN N Y <br />Filed: 03/07/2015 02 :66 PM <br />Taxpayer Name and Mailing Address <br />JOAQUIN Y TELLEZ HERRERA <br />319 S WALNUT ST APT 202 <br />GRAND ISLAND NE 68801 <br />No. 362t P. 1 <br />I certify that the Nebraska Department of Revenue has compiled with the laws of the State of Nebraska In determining the amount shown to be due, <br />and that the taxpayer has failed to pay the amount due after demand. Thla Notice of State Tax Llen Is an effective lien and serves to continue the priority of <br />the S i' s interes in t ' affected property of he taxpayer. <br />Revenue Agent 03/06/2018 (402)471 -6043 <br />Title Date Phone Number <br />Revenue Supervisor 03/06/2018 <br />Au prized signature Title Dale <br />4-404 Rev. 9 - 2013 Supersedes 4.949 Rev, 2.2002 <br />