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May. 25. 2013 04FM NE Secretary _t State — UCC <br />Nebreeke Department of <br />REVENUE <br />.. Nebraska ID Number <br />35278285 <br />Lien Serial Number <br />11807012 <br />Data of Lien <br />May 21, 2018 <br />Business Name and Location Address <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.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 />sign <br />here <br />Mal <br />r ued . i+ alure ' <br />Notice of State Tax Lien <br />Lien Pied With. <br />Fle®tsler of Deeds 0 County Clerk <br />LleaType; <br />® Original 0 Continuation <br />Federal ID Number <br />Social Security Number <br />XXX -XX -9901 <br />0 Corrected <br />Title Dale <br />Revenue Supervisor <br />20181)3E312 <br />Sec of Ste4 Jot,n a W. • LIE[ STL <br />fdgta8l244e -6 Pas; 1 <br />REYES ANDRES M <br />Filed: d5/251201B 10'16 AM <br />County <br />BALL <br />PLEASE DO NOT WRITE IN THIS SPACE <br />PLEASE RETURN TO; <br />NEBRASKA DEPT OF REVENUE <br />PO BOX 94609 <br />LINCOLN NE 68509 -4609 <br />Taxpayer Name and Mailing Address <br />ANDRES M REYES <br />2304 W BLAKE ST <br />GRAND ISLAND NE 68803 <br />Spouse's Social Security Number <br />Tax Program <br />Individual <br />Tax Period <br />2016 <br />Date of <br />Assessment <br />05/24/2017 <br />Tax <br />$1,471.00 <br />Penalty <br />$73.55 <br />Interest <br />$48.48 <br />Costs <br />Total <br />Total Due <br />1,593.03 <br />$1,593.03 <br />I certify that the Nebraska Department of fievenua has complied with the laws of the Stale of Nebraska In determinIng the amount shown to be due. <br />and that the taxpayer h - r. - • to r . ' mount due after demand. This Notice of Slate Tax Lien la an effective lien and serves to continue the priority of <br />the States interest in alleCte •roperty ayer. <br />Revenue Agent 05/21/2018 <br />(308)632 -1206 <br />Phone Number <br />05/21/2018 <br />Title Dale <br />4 - 491 - 1071 Rev. a -2013 Superaedea 4- 940.19)4 Rev. 2-2002 <br />