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Sep. 10 2:10 9 1.FM NE Secretary of State <br />Good Life. Great service. <br />0Ewsa!NLNT Of REV... <br />Nebraska ID Number <br />42030366 <br />Lien Serial Number <br />11814224 <br />Date of Lien <br />September 14, 2018 <br />sign <br />here <br />Lien Type: <br />® Original <br />Business Name and Location Address <br />Notice of State Tax Lien <br />Thls 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 end 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 />Lien Filed Wilk <br />y Register el Deeds p County Clerk <br />DConllnuation <br />Tale <br />Federal D <br />PLEASE DO NOT WRITE IN THIS SPACE <br />Social Security Number <br />XXX -XX -3953 <br />PLEASE RETURN TO: <br />NEBRASKA DEPT OF REVENUE <br />PO BOX 94609 <br />LINCOLN NE 68509 -4609 <br />Corrected <br />N_,, H966 F <br />201806131 <br />NE of Vote John N Oslo - YCC STL <br />9916$19603 -5 Pgs <br />BARGENAS ANGELA M <br />Filed: 09/16/2016 11:09 AM <br />County <br />HALL <br />ANGELA M BARCENAS <br />CARLOS A BARCENAS <br />422 WEST 10TH STREET <br />GRAND ISLAND NE 68801 <br />Spouses Social Security Number <br />XXX -XX -5168 <br />Taxpayer Name and Mailing Address <br />Tax Program <br />Individual <br />Individual <br />Date of <br />Assessment <br />Tax Period <br />05/24/2017 <br />2017 05/23/2018 <br />2016 <br />Tax <br />$3,193.00 <br />$929.00 <br />Penalty <br />$159.65 <br />$60.49 <br />Interest <br />$135.68 <br />$11.61 <br />Costs <br />Total <br />Total Due <br />3,488.33 <br />1,001.10 <br />$4,489.43 <br />I certify that Ne Nebraska Department of Revenue has complied with the laws of the State of Nebraska in determining the amount shown to be due, <br />and that the taxpayer h- . -d 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 Stets': inter' .t In r,=t cted prop.: ty of the taxpayer, <br />Revenue Supervisor 09/14/2018 (308)632 -1201 <br />-Foie Date Phone Number <br />Revenue Supervisor 09/14/2018 <br />Dale <br />4.494 -1974 Rey. E Sut,e.aedes 4- 949 -1974 tie 9 -220019 <br />