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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 />2015 <br />06/06/2017 <br />$940.00 <br />$47.00 <br />$53.38 <br />1,040.38 <br />Total <br />$1,040.38 <br />Mar. 12, 2013 2:52PM <br />o <br />PLEASE RETURN TO: <br />NEBRASKA DEPT OF REVENUE <br />PO BOX 94609 <br />LINCOLN NE 68509 -4609 <br />Nebraska Da partment of <br />REVENUE <br />This Notice of State Tax Llen 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 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 />Nebraska ID Number <br />47766115 <br />Lien Serial Number <br />11803079 <br />Date of Lien <br />March . 07, 2018 <br />sign <br />here Preparer` <br />Business Name and Location Address <br />Aulhortaed Signature <br />Nobrask <br />yer has <br />at in the a <br />E Secretary of State - UCC <br />Lien Flied With: <br />® Register of Deeds <br />Lien Type; <br />® Original <br />&unikt\olyik <br />▪ County Clerk <br />▪ Continuation <br />201801494 <br />Notice of State Tax Lien <br />PLEASE DO NOT WRITE IN THIS SPACE <br />Federal ID Number <br />Social Security Number <br />XXX -XX -0047 <br />Corrected <br />NE Sae eF Stsiw John A Gale - LICE STL <br />9918807407-1 Pis 1 <br />MARTINEZ PARRA JAIME <br />Filed: 0s/12r201e 10:24 laII <br />County <br />HALL <br />JAIME MARTINEZ PARRA <br />102 N LANE <br />GRAND ISLAND NE 68803 <br />No. 366J F. 2 <br />Spouse's Social Security Number <br />Taxpayer Name and Maililyq Address <br />Department of Revenue has compiled with the laws of the State of Nebraska in determining the amount shown to be due. <br />pay the amount duo after demand, Thla Notice of State Tax Lien Is an effective lien and moves to continue the priority of <br />sled property of the taxpayer. <br />Revenue Agent 03/07/2018 (30632 -1210 <br />Title i Date Phone Number <br />RP tte - 11 Mer P4 03/07/2018 <br />Title Dale <br />4-494 - 197d Rev. B -2013 Supersedes 4.949-1974 Rev. 2-2002 <br />