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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 />2016 <br />05/24/2017 <br />$2,709.00 <br />$135.45 <br />$102.65 <br />, Z947.10 <br />Total <br />$2,947.10 <br />Jul 23.2018 2: 8FM NE Secretary k State 201804719 No. 0652 F. 2/3 <br />Nebraska Department of <br />REVENUE <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 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 />41005538 <br />Lien Serta1 Number <br />11810394 <br />Lien type= <br />Notice of State Tax Lien <br />Lien Hied mat <br />Reylsiar of Deeds ❑ County Clerk <br />Federal ID Number <br />Social Security Number <br />XXX-XX -5264 <br />Dete of Lien <br />July 20, 2018 1:81 original ['Continuation ❑ Corrected <br />Business Name and Location Address <br />sign <br />here <br />Prepa <br />Title <br />Revenue Supervisor <br />N4 See er Sia to Jeer, a Asia - UCC 511 <br />9918815355-7 P9e: 1 <br />ACEVEDO FLEX <br />Filed: 07/23/201B 10:31 RN <br />ALEX ACEVEDO <br />B17 W 16TH <br />GRAND ISLAND NE 68801 <br />PLEASE DO NOT WRITE IN THIS SPACE <br />Spouse's Social Security Number <br />county <br />HALL <br />Tax •a er Name and Mellln, Address <br />I certify that the Nebraska Department of Revenue hea complied with the laws of the State of Nebraska In determining the amount shown to be due, <br />and that the taxpayer has failed to pay the amount due after demand.This Notice or State Tax Lien Is an effective lien and Serves to continue the priority of <br />the Slate's Interest In the properly of the taxpayer, <br />Revenu, eta ent <br />AUthodzed Skin re Date <br />4. 424-1274 flex 6-20n3 Supersedes 4- 940 -1074 Rev.2-2002 <br />07/20/2018 (308)632 -1203 <br />Date Phone Number <br />07/20/2018 <br />