Laserfiche WebLink
N_ B-RAW-A- <br />Cecr�_r`r. Gree'. Se ....e. <br />201906758 <br />NE Sec of State - Robert B. Evncn <br />Filing Document #: 1910001682-0 Pages: 1 <br />Debtor Name: CHAD CLEMENS <br />Filing Date and Time: 10/29/2019 11:22 AM <br />Notice of State Tax Lien <br />This Notice of State Tax Lien is issued by the Nebraska 'PLEASE DO NOT WRITE IN THIS SPACE <br />Department of Revenue for unpaid taxes administered by the Tax <br />Commissioner. Taxes, including penalties, interest, and costs, PLEASE RETURN T0: <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 NEBRASKA DEPT OF REVENUE <br />in the county and rights to property owned by the taxpayer or PO BOX 94609 <br />acquired before the expiration of this lien.This lien will expire and LINCOLN NE 68509-4609 <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 Hen or continuation statement. <br />Nebraska ID Number <br />94851050 <br />Federal D Number <br />Lien Serial Number <br />11942181 <br />L;en Feed won <br />Register of Deeds 0 County Cle'k <br />Social Security Number <br />XXX -XX -6520 <br />Spouses Social Secae Iy Number <br />Cala of Len <br />October 24, 2019 <br />Leen Type: County <br />® Crigenal 0 Continuation 0 Corrected HALL <br />Business Name and Location Address <br />Taxpayer Name and Mailing Address <br />CHAD CLEMENS <br />423 W 5TH <br />GRAND ISLAND NE 68801 <br />Tax Program Tax Period <br />Date of <br />Assessment <br />Tax <br />Penalty <br />Interest <br />Costs Total Due <br />Individual 2013 <br />05/25/2019 <br />$1,841.00 <br />$460.25 <br />$335.31 <br />I 2,636.56 <br />Total i $2,636.56 <br />I certify that the Nebraska Department of Revenue has cornplied with the laws of the State of Nebraska in oelerain',ng the amount shown to be due. <br />and that the taxpayer has faded to pay the amount due alter demand. 1 his Notice of Stale Tax Lien is an effective hen and serves to coarse the priority o` <br />Um Slates interest in thr-affeCl6 <br />piaffl —ekr,e 0 r. <br />sign .-< •i� ' <br />Title <br />Agent 10/24/2019 <br />(308)632-1206 <br />herePrepa r'igne{ure / <br />Date Phone Number <br />/' / Revenue Supervisor 10/24/2019 <br />Authorizedre ?filo Oatc <br />4494-19'4 Rev. 8-2C1B S.isers.Mes 4.94S.14174 Rev. 8-2C13 <br />