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Mar. 23. 2018 2:30V1 E Secretary of Stag — UCC <br />NehraeKe Oeperimant of <br />REVENUE <br />• <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 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 />Nebraska ID Number <br />47174498 <br />Lien Serial Number <br />11803672 <br />Date of Lien <br />March 19, 2018 <br />Business <br />sign <br />here <br />Autnoriiee Signature <br />Notice of State Tax Lien <br />Lien Flied With: <br />® Register DI Deeds ❑ County Clerk <br />Lien Type: <br />Original 0 Continuation <br />Name and Location Address <br />PLEASE DO NOT WRITE IN THIS SPACE <br />Federal ID Number <br />Social Security Number <br />XXX -XX -3534 <br />El Corrected <br />Tax pa <br />Tax Program <br />Individual <br />Individual <br />Tax Period <br />2015 <br />2016 <br />Date of <br />Assessment <br />05/24/2017 <br />05/19/2017 <br />$1,751.00 <br />Penalty <br />$86.00 <br />$87.55 <br />Interest <br />$19.88 <br />Costs <br />Tax <br />$344.00 <br />$48.64 <br />Total <br />Total Due <br />449.88 <br />1,887.19 <br />$2,337.07 <br />I h t th the taxpayer mat tae Nebraska 13 t o - ee amount due after demand. This is Notice of State Tax Lien is an effective lien and serves to COnti en to be ciusr. <br />and t the priority of <br />its th �� d to • <br />the Slate's interest in . l •roper a la r = yer. <br />Revenue Agent <br />Title <br />Revenue <br />Title <br />PLEASE RETURN TO: <br />NEBRASKA DEPT OF REVENUE <br />PO BOX 94609 <br />LINCOLN NE 68509 -4609 <br />rl! Ssc of C5*i� iohn a eel- - Y[[ 5 TL <br />9918808 S -7 PO: 1 <br />PEREZ RLEJRNDNO RUS1 <br />Filed: 08123!2618 01:53 Pm <br />2di$ 1 Pi 9 <br />Spouses Social Security Number <br />County <br />HALL <br />er Name and Mailing Address <br />ALEJANDRO RUBI PEREZ <br />583 E 19TH ST <br />GRAND ISLAND NE 68801 <br />03/19/2018 <br />Date <br />(308)632 -1206 <br />Phone Number <br />03/19/201B <br />Date <br />i' <br />4.454 -1974 Rev, p 2013 Supersedes 4-910 -1924 Rev. 24002 '•\ <br />