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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 />$1,590.00 <br />$79.50 <br />$62.73 <br />1,732.23 <br />Total <br />$1,732.23 <br />Au g, 13. 2_l0 1 3 3:34 FM NE Secretary ,f State <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 />94070628 <br />Lien Serial Number <br />11611696 <br />Date of Lien <br />August 08, 2018 <br />sign <br />here <br />I certify that the Nebraska Department of <br />and That the toe ..yer has failed <br />the slate's Interim <br />Lien Type: <br />® Original <br />Notice of State Tax Lien <br />Business Name and Location Address <br />Authorized Signatu�� <br />Lien Filed With; <br />Register of Deeda EJ County CIeriC <br />ount due <br />the to <br />Continuation <br />Federal ID Number <br />Social Security Number <br />XXX -XX -2063 <br />D Corrected <br />e has complied with the laws of the State of Nebraska In determInhtg the amount Shown lo be due, <br />emend. Thla Notice of State Talc Lien is an effective lien and serves lo continue the prlorlty of <br />Revenue Assent <br />PLEASE DO NOT WRITE IN THIS SPACE <br />PLEASE RETURN TO: <br />NEBRASKA DEPT OF REVENUE <br />6Ox 94609 • <br />LINCOLN NE 68509 -4609 <br />County <br />HALL <br />No. 0772 F. 2%2 <br />201805281 <br />5•c e1 P a. <br />i }e }e Senn I • uce srt. <br />tSG <br />Pas: 1 <br />99188 -0 <br />VElad 0 ANGEL <br />312e12 10:2 AM <br />Spouse's Soolal Security Number <br />Taxpayer Name and Mailing Address <br />ANGEL VELASCO <br />110 EAST 6TH ST APT 1 <br />GRAND ISLAND NE 68801 <br />08/08/2018 (308)632 -1206 <br />Dale Phone Number <br />08/08/2018 <br />Tide <br />Revenue Supervisor <br />Title Date <br />4494 -1974 Ray. 8.2013 Supersede6 4- 949 -1ei4 F ay.2.2002 <br />0 <br />