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N_E_BRA-S-KA- <br />eat S0'....e <br />11111.44+11.1 •I'Vr.of <br />20190655, <br />NE Sec of State - Robert B. Evnen <br />Filing Document #: 1910001234-7 Pages: I <br />Debtor Name: EDY 0 RAXCACO MENDOZA <br />Filing Date and Time: 10/21/2019 10:39 AM <br />Notice of State Tax Lien <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 />PLEASE RETURN TO: <br />NEBRASKA DEPT OF REVENUE <br />PO BOX 94609 <br />LINCOLN NE 68509-4609 <br />Nebraska ID Number <br />96450193 <br />Federal D Numher <br />Llan Serial Number <br />11941372 <br />Lien Cited With: Sooat Sec. ily Number <br />® Register ct Deeds ❑ County Clerk XXX -XX -5015 <br />se's Social Security Number <br />Date of Lee <br />October 17, 2019 <br />en Type: <br />® Onginai <br />Continuation <br />Corrected <br />County <br />HALL <br />Business Name and Location Address <br />Taxpayer Name and Mailing Address <br />EDY 0 RAXCACO MENDOZA <br />605 E 11TH ST APT A <br />GRAND ISLAND NE 68801 <br />Tax Program <br />Tax Period <br />Date of <br />Assessment <br />Tax <br />Penalty <br />Interest <br />Costs <br />Total Due <br />Individual <br />2018 <br />06/07/2019 <br />$426.00 <br />$21.30 <br />$10.80 <br />458.10 <br />Total $458.10 <br />sign <br />here <br />I candy that the Nebraska Department of Revenue has complied wen the teas of the Stale of Nebraska in delermioing the amount shown to be due. <br />and that the taxpayer has I to payerou -due alter demand. The Not,ce el Sate Tax Lien is an affective lien and serves Ic continue the priority of <br />the State's interest in thena d pray ny oft6e taxpayer. <br />Prepare, s nature <br />Si(Li) <br />ec Signature <br />Revenue Agent <br />10/17/2019 (308)632-1206 <br />Tele <br />Revenue - <br />i Date Phone Number <br />10/17/2019 <br />Tule <br />Date <br />asy4.19'a nn .rsenes 4-9a9-1974 Re...11.2013 <br />