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State of Nebraska 8/16/2019 4:00:45 PM PAGE 6/007 Fax Server
<br />PI.EASU RETURN N TO:
<br />NEBRASKA DEPT Of REVENUE
<br />PO 80X ,14609
<br />LINCOLN NE .88509-460.a
<br />I Y.W_RASKi`'
<br />NE Sec of State - Robert R. Evnen
<br />Filing Document #: 1908000933-9
<br />Debtor Name. JASON C LAWHORNE
<br />Filing D ate and Time 08/16/2019 0121 FM
<br />Pages 1
<br />Notice of State Tax Lien
<br />201904948
<br />This Notice of State 'Fax Lien is issued by the Nebraska
<br />Department of Revenue lot unpaid taxes administered by the Tax
<br />Commissioner, Taxes, including penalties, interest, and costs,
<br />which are shown below, aro due from the taxpayer and retrain
<br />unpaid atter dentard.These axes are a lien for all property located
<br />in fbe county and rights to property owned by the taxpayer or
<br />aogti red before the expiration of this lie s.This lien will expire and
<br />become unenforceable la years after the date of recording it no
<br />continuation statement is recorded on or prior to the expiration of
<br />the previous lien or continuation statement.
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<br />32870477
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<br />PLEAS€. DO NOT Wttri E: itirnieS SPACE
<br />August 09, 2019
<br />NizrnI;o:
<br />I XXX -XX 0229
<br />HALL
<br />Business Name and Location ,tddrees Taxpayer Name and ibtaihng Address
<br />Tax Program
<br />Tax Pe: iad
<br />inc ividua'. 2011
<br />.^livid::3i
<br />JASON C LAWHORNE
<br />339 SOWN OAK STREET
<br />GRANO ISLAND NE 880.1
<br />Dale of Tax
<br />I Assessment
<br />12131/2015 53,431.00
<br />2012 12131!2018 54.073.00
<br />Penalty interest
<br />C,^:413
<br />Total Doe
<br />5870.25 5-556.25
<br />51,018 25 521.63
<br />5,207 49
<br />y't2
<br />Tota!
<br />11,120 3E
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