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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 />2015 <br />07/15/2016 <br />$225.00 <br />$11.25 <br />$16.27 <br />252.52 <br />Total <br />$252.52 <br />- -�, 13. 2013 3:15FM NE 'Secretary c,f Stat <br />Good Life. Great Service. <br />Date of Lien <br />sign <br />here <br />G.AYTMLNT K YLVLNUL <br />Nebraska ID Number <br />93309694 <br />September 12, 2018 <br />Lien Serial Number <br />11814032 <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 Ilen or continuation statement. <br />e <br />re atu <br />orize• alure <br />Notice of State Tax Lien <br />Lien Filed Wlth <br />Register of Deeds ❑ County Clerk <br />Lien Type: <br />® Original <br />Business Name and Location Address <br />10 Continuation <br />PLEASE DO NOT WRITE 1N THIS SPACE <br />Federal D Number <br />Social Security Number <br />XXX -XX -1924 <br />Revenue Supervisor <br />N <br />9918 818807 -9 <br />MARTINEZ JOSE NB: 1 <br />FlI.d: 09/1e/2018 11:21 Rlq <br />PLEASE RETURN TO: <br />NEBRASKA DEPT OF REVENUE <br />PO BOX 94609 <br />LINCOLN NE 68509 -4609 <br />Corrected <br />JOSE MARTINEZ <br />1219 WEST 11TH STREET <br />GRAND ISLAND NE 68801 <br />Vol 1)966 <br />2418461 <br />Spouse's Sooial Sedulity Number <br />County <br />HALL <br />Taxpayer Name and Mailing Address <br />I certify that the Nebraska Department or Revenue has complied with the laws of the State ol 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 of State Tax Lien I an effective Ilen and aervea to continue the priority ol <br />the ' : ='a Interest in affected propey� • 1 the taxpayer. <br />hiri� Slt�n Title <br />Revenue Supervisor <br />09/12/2018 <br />Dale <br />(308)632 -1201 <br />Phone Nurrlber <br />09/12/2018 <br />Title Date <br />44941974 Rev 8-2018 Supersedes 4-949 -1974 Ray 8 -2013 <br />