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NEBRASKA <br />NE Sec of State - Robert B. Evnen <br />Filing Document #: 1909001243-9 Pages: 1 <br />Debtor Name: CI IRISTIAN E PEREZ <br />Filing Date and Time: 09/26/2019 08:58 AM <br />Notice of State Tax Lien <br />201905931 <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 lien. 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 THIS SPACE <br />Nebraska ID Number <br />96642203 <br />Federal ID Number <br />Lier Serial Number <br />11938927 <br />yak, 01 L <br />September 24, 2019 <br />Lien Filed With <br />tiefpster CI Deeds <br />len type <br />Gricirral <br />[] County Clerk <br />Soa al Security Number <br />XXX -XX -4404 <br />Spouses Social Security Number <br />Continuation <br />Business Name and Location Address <br />County <br />❑wrreaou HALL <br />Taxpayer Name and Mailing Address <br />CHRISTIAN E PEREZ <br />122 E 14TH ST <br />GRAND ISLAND NE 68801 <br />Tax Program Tax Period <br />Date of <br />Assessment <br />Tax <br />Penalty j Interest <br />Costs <br />Total Due <br />Individual 2017 <br />03/05/0019 <br />S4O0.00 <br />$20.001 523.17 <br />443.17 <br />Total <br />5443.17 <br />sign <br />here <br />I Certify that the Nebraska* Department of Reverwe has complied with the laws 01 ire Stato of Nebraska in determining the amount shown l0 l,; duo. <br />and Ina/ the taxpayer has failed to pay the amount due atter demand. T tits Nonce 01 Slat: Tax Lier, is an elfeel to lien a^d serves to commie the priority of <br />the Slukis is serest ir. ;Ire atto,9 d property of the taxpayer. <br />t,( -1)3t ri <br />Revenue Agent <br />rer3 Signature J,/ u Title <br />-- 1' p/ -t., %ir i!%_�. Revenue Supervisor <br />Autizprized Signature Title <br />09/24/2019 (4021471-5713 <br />Dale Phone Number <br />09/24/2019 <br />Date <br />4-494 '9,.1 Fier 0-7:i1F1 Supn-rMm /.-3A1-1a74 ,nev 0-2013 <br />