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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 />2,947.10 <br />Total <br />$2,947.10 <br />•!u1.2I.2018 2:58FM <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 lien.This Tien 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 $etial Number <br />11810394 <br />Date of Lion <br />July 20, 2018 <br />sign <br />here Prepa <br />Lien Filed With; <br />® neglaler of Deeds ❑ County Clerk <br />Lienr,pe: <br />Original C) Continuation ❑ Corrected <br />Business Name and Location Address <br />NE ,r of Stet: 201804720 No. 0652 F. <br />Notice of State Tax Lien <br />Ni Sac o1 C4,4. Jahn A GAM UCC <br />9916818359 -9 PPS: <br />ACEVEDO ALEX <br />Filed: 07/23/2018 10:31 FM <br />PLEASE DO NOT WRITE IN THIS SPACE <br />Federal ID Number <br />Social Security Number <br />XXX -XX -5264 <br />oounty <br />HALL <br />Taxpayer Name and Mailing Address <br />ALEX ACEVEDO <br />817 W 16TH <br />GRAND ISLAND NE 68801 <br />STL <br />1 <br />spouse's Social Security Number <br />I certify Nit the Nebraska Department of Revenue has compied with the laws of the State of Nebraska in determining the amount shown to be due, <br />and that the taxpayer has felled to pay the amount due after demand. This Notice of State Tax Llen Is an effective lien and series to continue the priority 01 <br />Ina State's interest in the affec J property al the taxpvtyer. <br />4 Revenue Agent <br />if4prilt <br />Authorized Si vir Title <br />Title <br />Revenue Supervisor <br />07/20/2018 (308)632 -1203 <br />Date Phone Number <br />07/20/2018 <br />Dale <br />4.494.1914 Rev. B -2013 SuOereeier 4.4440976 Rev. 2.2002 <br />