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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 />2011 <br />04/14/2015 <br />$469.00 <br />$24-45 <br />$94.35 <br />lA Original ■ Continuation <br />607.80 <br />Total <br />$607.80 <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 Iten.Thls 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 />Nebraska ID Number <br />97165999 <br />Federal ID Number <br />lien Serial Number <br />11804345 <br />Lien Filed With: <br />Social Security Number <br />XXX-XX -8078 <br />Spouse's Social Security Number <br />® Register or Deeds ■ County Clerk <br />Dale of Lien <br />March 29, 2018 <br />Lien 'type: <br />County <br />HALL <br />lA Original ■ Continuation <br />■ Corrected <br />cf <br />Apr, 2. 2018 3:06FM NE Secretary of State — UCC No. 3915 P. 2/2 <br />Nebraska Department of <br />REVENUE <br />Business Name and Location Address <br />sign <br />here <br />I certify that the Nebraska Department of Revenue has complied with the laws W the Stale of Nebraska In determining the amount shown to be due, <br />that the taxpayer has railed to pay the amount due after demand. This Notice of Stale Tax Lien is an elective Nen and serves to continue the priority of <br />e s late's Interest in the ens ad property of the taxpayer. <br />fireper_ Signature <br />u rizeDSignature <br />20180208c1 <br />Notice of State Tax Lien <br />NE Lee oleM A luicc <br />- <br />991 aee8474-a P 1 <br />RODRIGUEZ SANTANA ARM'S <br />Filed: 04 / 0 2/2016 11•0 AM <br />Taxpayer Name and Mailing Address <br />ARAMIS RODRIGUEZ SANTANA <br />14171N 1ST ST <br />GRAND ISLAND NE 68801 <br />Revenue Agent 03/29/2018 (402)471 -5713 <br />- nue Date Phone Number <br />Revenue Supervisor 03/29/2018 <br />Title Date <br />44241974 Rev. 8-2013 Supersedes 4949 -1974 Rev.2 -2002 <br />