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NEB AS44A- <br />I=T, breve S_•V <br />201907022 <br />NE Sec of State - Robert B. Evnen <br />Filing Document #: 1911000386-1 Pages: 1 <br />Debtor Name: JEREMY TITMAN <br />Filing Date and Time: 11/07/2019 11:22 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 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 />Nebrasxa ID Number <br />11820845 <br />Federal ID Number <br />Lien Serial Number <br />11942867 <br />Lien Flied With: <br />Q Register of Deeds ❑ County Clerk <br />Social Security Number <br />XXX -XX -3834 <br />Spouse's Social Security Number <br />Date of Len <br />November 5, 2019 <br />Lien Type. <br />Q O. incl ❑ Continuation ❑Corrected <br />County <br />HALL <br />Business Name and Location Address <br />Taxpayer Name and Mailing Address <br />JEREMY TITMAN <br />2615 COCHIN <br />GRAND ISLAND NE 68801 <br />Tax Program Tax Period <br />Date of <br />Assessment <br />Tax <br />Penalty <br />Interest <br />Costs <br />Total Due <br />Sales 10710112016 - 0113112017 <br />4/0312017 <br />.00 <br />158.96 <br />22.81 <br />.00 <br />181.77 <br />Sales 10310112017 - 03/3112017 <br />1010212017 <br />.00 <br />25.00 <br />.49 <br />.00 <br />25.49 <br />Sales 10510112017 - 06/30.2017 <br />.00 <br />50.00 <br />2.76 <br />.00 <br />52.76 <br />Sales 107/0112017 - 08131/20t7 <br />I I <br />.00 <br />50.00 <br />.27 <br />.00 <br />50.27 <br />Sales 09/0112017 - 09130/2018 <br />1213112018 <br />3.120.00 <br />637.00 <br />197.35 <br />.00 <br />3,954.35 <br />Total <br />4,264.64 <br />I certify that use Net,. ska Department of Revenue has complied with the laws of the State of Nobraska in determining the amount shown to be due, <br />and that h: . xpayer has ailed to •,- r+ = amauct,due atter demand. This Notice of State Tax Lien is an effective leen and Serves to continue the priority of <br />r� t1Int fps -. prnp: ty of the taxpayer. —" <br />Revenue Agent <br />Title <br />Revenue Senior Agent <br />Title <br />11/05/2019 402-471-5788 <br />Date Phone Number <br />/1-S—f 7 <br />Date <br />4.494-1n74 Rev. &2018 Supersedes 4449.1979 Rey. 8-2013 <br />