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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 />2012 <br />06/27/2016 <br />$1,030.00 <br />$370.30 <br />$193,57 <br />be Of Llen <br />June 01, 2018 <br />1.593.87 <br />Total <br />$1,593.87 <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 Iien.This lien will expire and <br />become unenforceable 10 year 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 <br />DO NOT <br />NE saw of <br />1 <br />I I � <br />�' I <br />�h <br />0016812954 <br />ROJAS <br />Filed: <br />WRITE <br />sli. +o John <br />1 �I l <br />�I,� �I <br />! j l �� <br />I �j4'1 1 '1 <br />-7 <br />Kato D <br />08/04/2010 <br />IN THIS SPACE <br />a e.i.. <br />��,1 �I <br />��, <br />! li � <br />I 6 <br />10;37 <br />ACC sn <br />" I <br />�� � <br />PBS <br />AM <br />• <br />Nebraska ID Number <br />47752351 <br />Federal ID Number <br />Lien Serial Number <br />11807792 <br />Lien Filed With: ' <br />n Re of Deeds D County Clerk <br />Social Security Number <br />XXX_XX 4846 <br />Spouse's Social Security Number <br />XXX -XX -5451 <br />be Of Llen <br />June 01, 2018 <br />Lien Type <br />® original ❑ Continuation DCorrected <br />County <br />HALL <br />tun. <br />Nebraska Department of <br />REVENUE <br />sign <br />here Prep. <br />2118 3:21P'M NE Secretary o State — UCC No. 4:94 P. 2 <br />201803544 <br />PLEASE RETURN TO: <br />NEBRASKA DEPT OF REVENUE <br />PO BOX 94609 <br />LINCOLN NE 68509 -4609 <br />Business Name and Location Address <br />Authorized Signs <br />Notice of State Tax Lien <br />Taxpayer Name and Mailing Address <br />KALA D ROJAS <br />VICTOR G ROJAS <br />5062 S 108TH PMB 246 <br />OMAHA NE 68137 <br />1 certify that the Nebraska Department of Revenue has complied wIlh the laws of the State of Nebraska In determining the amount shown to be due. <br />and (hal the taxpayer has failed to pay the amount due after demand. This Notice of State Tax Lien Is an effective lien and serves to continue the priority of <br />the Slate's interest b1 the affect property of the taxpayer. <br />Revenue Agent 06/01/2018 (308)632 -1203 <br />Title Date Phone Number <br />Revenue Supervisor 06/01/2018 <br />Tide Dale <br />4.4N4.1e74 Rev, 8 Supersedes 4999 -1974 Rev. 2 -2002 <br />v <br />