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Tax Program Tax Period Date of Assessment Tax Penalty Interest Costs Total Due Individual 2016 07/14/2017 $344.00 $17.20 $11.59 372.79 _ _ Total $372.79 L .Jun. 1. 2018 11 0UAM NE ' :,rotary o t 'State — UCC•• Nc. 4500 Nebraska Department of REVENUE Nebraska ID Number 92973841 Lien Serial Nufriber 11807567 Date of Hen May 30, 2018 sign here Notice of State Tax Lien This Notice of State Tax Lien is issued by the Nebraska Department of Revenue for unpaid taxes administered by the Tax Commissioner. Taxes, including penalties, interest, and costs, which are shown below, are due from the taxpayer and remain unpaid after demand,These taxes are a lien for all property located in the county and rights to property owned by the taxpayer or acquired before the expiration of this Iien.ThIs lien will expire and become unenforceable 10 years after the date of recording it no continuation statement is recorded on or prior to the expiration of the previous lien or continuation statement. Zlen Filed WItlt: ® Register of Deeds 0 County Clerk Lien Type: ® Original Business Name and Location Address 201803456 D Condnualion 0 Corrected Revenue Agent PLEASE o0 NOT WRITE IN THIS SPACE Federal l0 Number - samorsatarttyNUmt el XXX -XX -0076 !certify that the Nebraska Department oI Revenue has complied wtlh the laws of the State of Nebraska In determining the amount shown to be due, and that the taxpayer has faded to pay the amount due after defnand. T'hts Notice of State Tax Lien is an effective lien and serves to continue the priority of the State's Interest in the affected property of the taxpayer. Title Revenue Supervisor Tae NE Sac of Ste(a John 99 that 2Y04 -2 TORRES ZULUETR JORGE Filed! 06/01/201e 09;41 API County HALL Taxpar Name and Mailing Address JORGE TORRES ZULUETA 4115 SO CHERRY STREET APT J52 GRAND ISLAND NE 68801 A Gal Spouse's NEC ST/ Pga 1 05/30/2018 (402)471 -5713 Date Pnone Number 05/30/2018 Date 4 -a4 -1974 Rev. 8-2013 Supersedes 4- 949 -1974 Rev, x - 2002 .I.