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���J0ct.22.2ii13 35FM NE Secretary of Stat_ <br />V <br />PLEASE RETURN TO: <br />NEBRASKA DEPT OF REVENUE <br />PO BOX 94609 <br />LINCOLN NE 68509-4609 <br />Gxd Life. Baegr Sae=iM <br />Nc. 117 <br />NE Sec ofState • Jahn A. Gale <br />Faint Documan 9: 1110001494-11 Pages 1 <br />Debtor Name: DANIEL AOSALPS P n11atGT1'PT <br />Filing Date and Timm 1 0122/2011 02:49 PM <br />Notice of State Tax Lien <br />201806982 <br />This Notice o1 Stele Tax Llen is Issued by the Nebraska <br />Department of Revenue for unpaid taxes adminlatered by [heTax <br />Commissioner. Tars, including penalties, interest. end costs, <br />which are shown below, are due from the taxpayer and remain <br />unpaid after demand.Theae lases ere a lion fur all property located <br />in the county and rights to property owned by the taxpayer or <br />acquired before the expiration of this Tien. This lien will expire and <br />become unenforceable 10 years after the date of recording If no <br />continuation statement to recorded on or prior to the expiration of <br />the previous hen or continuation statement. <br />PLEASE OO NOT WRITE IN71-IIS SPACE <br />Nab,Oyle 10 Number <br />83830033 <br />Federal Kr Nurnbel <br />LJen %Mal Nifelber <br />11816885 <br />Liao FeOd Warr <br />Regimen of Dank ❑ County Oen <br />g0c'iaf S(Ldrlty rsionbor <br />XXX -XX -4995 <br />Spouse's Social Seetvhy Neett e <br />Data of -Lia <br />October 16, 2018 <br />Lien'rype: L_I ^�'T <br />Original continuation [JConecteo <br />County <br />HALL <br />Business Name and Location Address <br />Taxpayer Name end MaillnQ Address <br />DANIEL ROSALES RODRIGUEZ <br />314 NORTH DARR AVE <br />GRAND ISLAND NE 613503 <br />Tax Program <br />Tax Period <br />Date of <br />Assessment <br />Tax <br />Penalty <br />$18,70.. <br />Interest <br />517.84 <br />Coats <br />Total Due <br />431.54 <br />Individual <br />2016 <br />07/07/2017 <br />$394.00 <br />Total <br />5431.54 <br />sign <br />here <br />l cacti at the N+ reale <br />AM Hal . N,,V 4• WIt4 <br />gw Ela '' - ,T _aReo <br />Prapa <br />Imwa d Rawnua hag curgplied xdlh Os lea's or ate State of Netr9elea In delarmattrg Ito enxrad shown b be 400. <br />flay ate ardor. dde an4Y dan.and. Trig Nall e of Agra Tax Llan Is tan aPentlm lien and sal yea Ps cOnll,ue Iha pdai,ty d <br />ty of the leapayer. <br />Revenue Agent <br />Title <br />Revenue S pervisor <br />10/182418 (308)632-1210 <br />bob Phone Narnher <br />10/16/2015 <br />7hb cam <br />•.04.I0T Fler.8.4018 Stmergoger iAr9441r gey,54014 <br />