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State of Nebraska 9/4/2019 3:24:30 PM PAGE <br />PLEASE RETURN TO: <br />NEBRASKA DE. PT Or REVENUE <br />PO BOX 911609 <br />LINCOLN NE 68509-4609 <br />NP B -RAS KA - <br />3/005 Fax Server <br />201905415 <br />NE Sec of State - Robert B Evnen <br />Filing Document 1909000071-7 Pages: I <br />Debtor Name NICOL G JAROS <br />F ilmg Date and Tune 0W04/2019 11 04 AM <br />Notice of State Tax Lien <br />This Notice of Slate Tax Lien is issued by the Nebraska <br />Department of 'Revenue for unpaid taxes administered by the Tax <br />Commissioner. Taxes. including permities, 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 ail property located <br />in the county and rights to property otento by the taxpayer or <br />acquired before the expiration of this ien.This lien will expire and <br />become unenforceable 10 yosts atter 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 />'•:;;I:ozvf t"f <br />43387454 <br />w' SeItTe•-reyr <br />11936790 <br />trjcr <br />PLEASE DO NOT WAtTE IN THIS SPACE <br />• <br />w;01 <br />Cfo:46, F...)Coftoty Cf,‘!0.• <br />August 28, 2019 <br />sc.:4a: se .r.s.1,f mt.e; <br />XXX -XX -1534 <br />Ntvnbf:r <br />Business Neese and Location Address <br />Tax Program <br />Tax Period <br />• <br />t-0 <br />Assessment <br />2017 <br />HALL <br />Taxpayer f•teme. and Mailing Address 1, <br />Tax <br />mcot. G JAROS <br />518 E ASHTON AVE <br />GRAND ISLAND NE 58801 <br />Penalty ! Interest <br />Costs <br />Totai Due <br />05723i2018 S272.00 13_60 314.76 <br />J: <br />Total <br />300.36 <br />3300.36 <br />1 -»^ily h•!- k.hvs: .); 4,<. Stzte of N.5., -.4o14 <br />Fat ;..,oi . it- an <br />,s1c. <br />Revenue Aero 0B./28,2010 (303)832-1210 <br />Revenue Supervisor 08/2812019 <br />