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NEBRASKA - NE Sec of Slate - Robert R. Evnen Filing Document #: 1910000041-2 Pages: 1 Debtor Name: JASON M RHOADS Filing Date and Time: 10/01/2019 12:13 PM Notice of State Tax Lien 201906069 This Notice of State Tax Lien is issued by the Nebraska Department of Revenue for unpaid taxes administered by the Tax Commissioner. Taxes, including penalties, Interest, and costs, which are shown below, are due from the taxpayer and remain unpaid after demand.These taxes are a lien for all property located in the county and rights to property owned by the taxpayer or acquired before the expiration of this lien. This lien will expire and become unenforceable 10 years after the date of recording If no continuation statement is recorded on or prior to the expiration of the previous lien or continuation statement. PLEASE DO NOT WRITE IN THIS SPACE PLEASE RETURN TO: NEBRASKA DEPT OF REVENUE PO BOX 94609 LINCOLN NE 68509-4609 Nebraska It) Number 41805887 Federal 0 Number Len Serial Number 11938970 Leen Fjlgd Wish: I ] "t Dom 1 0 County uerx Soebe fur ty Nurt$b.: XXX -XX -1082 $000Ses Social Secanty Nufntie+ Dale 4t Lien September 24, 2019 L.en Type: ® Original ❑Cunlinualen ©Coreeiet +nty HALL Business Name and Location Address axpayer Name and Matting Address JASON M RHOADS 1003 W 9TH STREET GRAND ISLAND NE 68801 Tax Program Tax Period Date of Tax Assessment Penalty Interest Costs Total Due Individual 2015 10/24/2016 $852.00 $42.60 $100.49 995.09 Total $995.09 I certify that the Nebraska Department of Revenue has twiddled with Rra taws of the State of Nebraska at determining the amount shown to be due. and mat the taxpayer has taRe3 y ttte'IInppnrabe after demard.The Notice at State Tax Lien is an efiecfvo Dien and serves to continue the priority of the Starck ykinikk in the air p ty of -: taxpayer. -4 sign ri here " Pr Revenue Agent 09/24/2019 (308)632-1206 Tye Date Phone Number Revenue Supervisor 09/24/2019 Title, Date 4.:94.1974 44444 f.-7016 Suyemctles 4.9451974 flee 89917