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�..:, L'e (;-pat c‘,.•-•••749. <br />201906759 <br />NF. Sec of State - Robert B. Evnen <br />Filing Document #: 1910001751-9 <br />Debtor Name: ROBERTO SUAREZ ROJAS <br />Filing Date and Time: 10/29/2019 02:01 PM <br />Pages: 1 <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 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 DO NOT WRITE IN THIS SPACE <br />PLEASE RETURN TO: <br />NEBRASKA DEPT OF REVENUE <br />PO BOX 94b09 <br />LINCOLN NE 68509-4609 <br />Nebraska ID Nu nbe <br />95459677 <br />Federal ID Number <br />Lien Segel Number <br />11942083 <br />'Lien Filed With: <br />® Register of Deeds ❑ County Clerk <br />Social Security Number <br />XXX -XX -6173 <br />Spouses Social Sec, rity Number <br />Dare of Lien <br />October 24, 2019 <br />Len Type: <br />®Original [continuation rjCovected <br />County <br />HALL <br />ocatton Address <br />Taxpayer Name and Mailing Address <br />ROBERTO SUAREZ ROJAS <br />104 MELODY LANE <br />GRAND ISLAND NE 68803 <br />Tax Program <br />Tax Period <br />Date of <br />Assessment <br />Tax I Penalty <br />Interest Costs <br />Total Due <br />Individual <br />2017 <br />05/23/2018 <br />$302.00' $15.10 <br />$18.74; <br />335.84 <br />Individual <br />2018 <br />05/24/2019 <br />$414.001 $20.70 <br />S10.89 i <br />445.59 <br />Total <br />$781.43 <br />1 certify that the Nebraska Department of Revenue has complied with the lana of tee State of Nebraska in determining the amount shown to Le due. <br />and that the taxpayer has fa od to pay the amount due alter demand. 1 fon Notice of Stale Tax Lien s an effective lien and serves to continue the priori'y of <br />Ihd_State s,interest in the �tlitcTe3prgyerty ortke-ta+ayer. <br />sign \� ! ~ ,Ltr Revenue Agent 10/24/2019 (308)632-1206 <br />Repan r;a�ignalure Tiae <br />``l,/t Dale Phone <br />Number <br />here <br />�/ Revenue Supervisor 10/24/2019 <br />Authorized $iyr ye } , Talo D1te <br />4.494-1974 ne.. 6-20r8 S.4:ersaries 4-9a9-'9'4 Sea 8.20,1 <br />