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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 />$208.00 <br />$10.40 <br />$8.43 <br />1 Original II Continuation <br />226.83 <br />Total <br />$226.83 <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 Hen 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 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 />PLEASE DO NOT WRITE IN THIS SPACE <br />PLEASE RETURN TO: <br />NEBRASKA DEPT OF REVENUE <br />PO BOX 9460 <br />LINCOLN NE 68509 - 4609 <br />Nebraska ID Number <br />91936934 <br />Federal ID Number <br />Lien Serial Number <br />11812550 <br />Lien Fled With; <br />Social Security Number <br />XXX -X( -2960 <br />Spouse's Social Security Number <br />l'1 Register of Deeds • County Clerk <br />Data of Lien <br />August 21, 2018 <br />lien Type: <br />County <br />HALL <br />1 Original II Continuation <br />• Corrected <br />Aug. 24. 2013 3:12PM NE Secretary of State <br />Nebraska Department of <br />REVENUE <br />sign <br />h ere Prepare <br />Business Name and Location Address <br />Revenue Agent <br />Title <br />Revenue Supervisor <br />Title <br />NE Sec of Sta /e John A eel a '� LICE STL <br />11E1 <br />9915818455 -1 Pas: 1 <br />SOLLET SANDO YUDELKIS <br />Filed: 06/24/2018 11:09 RIB <br />Notice of State Tax Lien <br />Nc, 5847 P. 2 <br />20180556 <br />Taxpayer Name and Mailing Address <br />YUDELKIS SOLLET SANDO <br />3171/2 S LOCUST ST <br />GRAND ISLAND NE 68801 <br />I certify that the Nebraska De. = merd of Revenue has Complied with the laws of the Stale of Nebraska In determining the amount shown to be due, <br />and that the taxpayer has o p- mount . after demand. This Notice of State Tax Lien is an effective lien and serves to continue the priority of <br />the state's interest In the r. <br />08/21/2018 (308)632 -1206 <br />Date Phone Number <br />08/21/2018 <br />Date <br />4454-1 Her, 0.2015 Supersedes 4 -04e -1974 Req. 2-2502 <br />c <br />