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NJEER-A.6+4A <br />Goc ri L.,f,:. Greet S -v ce. <br />NE Sec of State - Robert B. Evnen <br />Filing Document #: 1909001007-9 Pages: 1 <br />Debtor Name: PHILIP E SMITH <br />Filing Date and Time: 09/23/2019 12:24 PM <br />Notice of State Tax Lien <br />201905848 <br />This Notice al 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 Ilen.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 />PLEASE DO NOT WRITE IN Tt l,S SPACE <br />Date of <br />Assessment <br />Nebraska ID Number <br />13596888 <br />Federal 10 Number <br />471695856 <br />Interest <br />lien Serial Number <br />11937067 <br />Lien Filed With: <br />M Register of Deeds 0 County Clerk <br />Social Security Number <br />XXX -XX -2678 <br />Spouse's Socia/ Security Number <br />04/23/2019 <br />Date of Lien <br />September 10, 2019 <br />Lien Type: <br />0Original [Continuation El Corrected <br />County <br />1IA1,1, <br />I <br />Business Name and Location Address <br />axpayer Name and Matlrng <br />PHILIP E SMITH <br />6700 TROOST AVE 109 <br />KANSAS CITY MO 64131 <br />Tax Program <br />Tax Period <br />Date of <br />Assessment <br />Tax <br />Penalty <br />Interest <br />Costs <br />Total Due <br />Saks <br />05/01/2014 - 07/31/2014 <br />04/23/2019 <br />2,569.19 <br />1,375.30 <br />475.80 <br />.00 <br />4,420.29 <br />Total <br />4,420.29 <br />sign <br />here <br />1 certify that the Nebraska Department of Revenue has complied with the laws of the State of Nebraska in determining the amount shown lo be due, <br />and ' at the taxpayer h,e5failed pay the amount due after deenand. This Notice of State Tax Lien Is an effective lien and serves to continue the priority o1 <br />the - ate's irferept in /,e a(f � ='• op ty of the taxpayer. <br />Revenue Agent 09/04/2019 402-471-5956 <br />Title Date Merle rsluiVer <br />ROMAV 40 Revenue Senior Agent 19/ 1% <br />Tido Date <br />4.49419,4 Sen 5-SOre Supraedes 4.949.14x4 555. 8-200 <br />