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NEBRA&KA- Gzoz 010.01/40if ItleoPtilf NE Sec of State - Robert B. Evnen Filing Document #: 1912001069-3 Pages: 1 Debtor Name: RANDY DACK Filing Date and Time: 12/20/2019 09:32 AM Notice of State Tax Lien 201908027 This Notice of State Tax Lien is issued by the Nebraska Department of Revenue for unpaid taxes administered by the Tax Commissioner. Taxes, including penalties, interest, and costs, which are shown below, are due from the taxpayer and remain unpaid after demand.These taxes are a lien for all property located in the county and rights to property owned by the taxpayer or acquired before the expiration of this lien.This lien will expire and become unenforceable 10 years after the date of recording if no continuation statement is recorded on or prior to the expiration of the previous lien or continuation statement. PIEDO NOT WRITE IN THIS SPACE Netrasaa ID Number 8696500 Federal 113 Na,fl1tt Lien Sehal No ' 119445,37 Lien Fdd Web: [K] Regime, ol D Ckuk SocaI Sooaney NumOOr X X X -XX -4443 SpoutaSoiaI Seco Date ol Lien December 5, 2019 Lien Type: Original 0 Continuation Ej Coeroe1n0 County HALL Business Name and Location Address Taxpayer Name and Mailing Address RANDY DACK 112 CAMPBELL DONIPI IAN NE 68832 Tax Program Tax Period Date of Assessment Tax Penalty Interest Costs Total Due Sales 01/01/2018 - 12/31,2018 08106/2019 470.00 94 00 20 54 .00 584.54 Total 58434 I certify that the Nebraska Department of Revenue has complied with We Imes of the Stale of Neteassa in deremuning the amount shown to be doe, and that the taxpayer hes failed to pay the amount due after demand. This Notice ol State Tax Lien is an eflective ben and serves to continue the priority of the States Interest In the allecied property of the West" sign ,e2 here ALMorized Sigraturo Revenue Agent 12/11/2019 402-471-5717 Tele Revenue Senior Agent Date Phone Number Title Date a-4941974 neva-2019 Seorniesex4545-t574 new. 0-2013