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Tex Program <br />Tax Period <br />Date of <br />Assessment <br />Tax <br />Penalty <br />Interest <br />Costs <br />Total Due <br />Individual <br />201 <br />05/16/2017 <br />$701.00 <br />$35.05 <br />$40.16 <br />776.21 <br />Total <br />$776.21 <br />This Notice of State Tax Lien is issued by the Nebraska <br />Department of Revenue for unpaid taxes administered by the Tax <br />Commissioner. Taxes, including penalties, Interest, and costs, <br />which are shown below, are due from the taxpayer and remain <br />unpaid after demand.These taxes are a lien for all property located <br />in the county and rights to property owned by the taxpayer or <br />acquired before the expiration of this lien.Thls lien will expire and <br />become unenforceable 10 years after the data of recording if no <br />continuation statement is recorded on or prior to the expiration of <br />the previous lien or continuation statement. <br />PLEASE DO NOT WRITE IN THIS SPACE <br />Nebraska ID Number <br />95856730 <br />Federal ID Number <br />Lien Serial Number <br />1180331 B <br />, Lien Fled With: <br />Social Security Numb <br />XXX -XX -6135 <br />Spouse's Social Security Number <br />r Register of Deeds I County Clerk <br />Date of Lien <br />March 13, 2018 <br />Lien Type: <br />❑Corrected <br />County <br />HALL <br />t;1 Original ❑Continuation <br />Mar. 15. 201$ 3.25PM NE Secretary of State — UCC No. 3717 P. 3 <br />Nebrasre Department of <br />REVENUE <br />sign <br />here <br />Business Name and Location Address <br />201801613 <br />Notice of State Tax Lien <br />NE Sr e of mete John A <br />0 <br />99188071348 -1 <br />LASTOR DIEGO <br />Filed: 03I15/201B 08:41 <br />Taxpayer Name and Mailing Address <br />DIEGO LASTOR <br />208 E 14TH ST <br />GRAND ISLAND NE 68801 <br />Revenue Agent <br />Title <br />Revenue Supervisor <br />Title <br />certify that <br />at the tax <br />te'a Inte <br />Au • rized Signature <br />Sale - II C !TL <br />P9s: 1 <br />RI7 <br />rasica Department 01 Revenue has complied with Inc laws of the Slate of Nebraska in determining the amount shown to be due, <br />has tailed to pay the amount due alley demand. This Notice of State Tax Lien is an effective lien and serves to continue the priority of <br />the affected property of the taxpayer. <br />(402)471 -5731 <br />Phone Number <br />03/13/2018 <br />Date <br />4- 49■-laid Rev. 84013 aupereesee 4449 -1974 Rev. 2-2002 <br />