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NE Sec of State - Robert 0. Evnen <br />Filing Document #: 1910000399-6 Pages: 1 <br />Debtor Name: MYCIIAL E WILLIS <br />Filing Date and Time: 10/07/2019 02:10 PM <br />NE8&A-644A <br />Notice of State Tax Lien <br />201906211 <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 Iien.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 00 NOT WRITE IN THIS SPACE <br />Nebraska ID Nmnber <br />48164429 <br />t.t era( I,5 Number <br />Lien Serial Number i en Wett Aln: <br />11939758 x /register et Deeds ❑ County Clerk <br />$octal Security Number <br />XXX -XX -5900 <br />Spouse's Soda'. Security Number <br />Cate of t. en -:. en Type. <br />October 02, 2019 : Original DContinuation 0c.,racloxf <br />Count; <br />HALL <br />Business Name and Location Address <br />Taxpayer Name and Mailing Address <br />MYCHAL E WILLIS <br />503 LEE JOHNSON RD UNIT 3 <br />DUNN NC 28334 <br />Tax Program Tax Period <br />Date of <br />Assessment <br />Tax <br />Penalty I Interest <br />Costs <br />Total Due <br />Individual 2016 <br />09/01/2017 S56100 <br />528.05 <br />549 95 <br />639 00 <br />Total <br />5639.00', <br />I rrt Iii/ that Sl e Nebra,ka Department of -leverue has complied with the Taws c' the State et Nebraska in decor -0n ng the amcunl snows to be cue, <br />and that the IaxpaY0' I:as lathed I a pay the areoulI due aleri demand. i his Nol:ee of Slate Tax _len is an effective lien and Serves t0 come .e the p00 00 m <br />Ihu Slalu's into res( in needed peeler ly all,. taxpayer <br />sign 4 �L Revenue Agent <br />here e� °reparSignature , Tale <br />.t"--_. _/- Revenue Supervisor <br />AuMarized Signature <br />l i <br />(402)471-5713 <br />t+hone Number <br />10/02/2019 <br />Title Date <br />ii.a9.1.190rr Ont 0.20'0 Stye e.0Gc d.9a9.197.1 Po.. 9.20'3 <br />