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202000522
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1/23/2020 3:50:52 PM
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1/23/2020 3:50:16 PM
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DEEDS
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202000522
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NEBRASKA- <br />Coice _,•�. �. „<� ,,'ca. <br />20200052 <br />NE Sec of State - Robert B. Evnen <br />Filing Document #: 2001001320-1 Pages: 1 <br />Debtor Name: OSCAR R. AMBRIZ <br />Filing Date and Time: 01/23/2020 10:28 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 />Nebraska ID Number <br />13388061 <br />Federal ID Number <br />841728909 <br />Lien Serial Number <br />12046571 <br />Lien Filed With <br />& P.egister of Deeds ❑ County Clerk <br />Social Security Number <br />XXX -XX -5228 <br />Spouse's Social Security Number <br />Dale of Lien <br />January 16,2020 <br />Lan Type: <br />❑r Original ❑Continuation ❑Corrected <br />County <br />HALL <br />Business Name and Location Address <br />Taxpayer Name and Mailing Address <br />OSCAR R. AMBRIZ <br />AL PASTOR <br />716SPINE ST. <br />GRAND ISLAND NF 68801 <br />Tax Program <br />Tax Period <br />Date of <br />Assessment <br />Tax <br />Penalty <br />Interest <br />Costs <br />Total Due <br />Sales <br />07/01/2019 - 07;31;2019 <br />01/02/2020 <br />164.52 <br />.00 <br />3.36 <br />.00 <br />167.88 <br />Sales <br />08;01/2019-08;:31/2019 <br />01/02/2020 <br />767.37 <br />76.74 <br />12.41 <br />.00 <br />856.52 <br />Sales <br />09/01/2019 - 09;30;2019 <br />01/02/2020 <br />679.26 <br />67.93 <br />8.19 <br />.00 <br />755.38 <br />Sales <br />10%01/2019 - 10!3112019 <br />01/02/2020 <br />49.23 <br />25.00 <br />.38 <br />.00 <br />74.61 <br />Total <br />1,854.39 <br />I certify that the Nexaska Department of Revenue has complied with the laws o1 the State of Nebraska in oetermining the amount shown to be due. <br />and mat the taxpayer ass faded to pay the amount due alter demand. This Notice of State Tax Lien is an effective lien and scans to continue the priority of <br />the State's Interest in the affected property of the taxpayor. <br />Revenue Agent <br />Revenue Senior Agent <br />01/09/2020 402-471-6067 <br />Date Phone Numtier <br />Dale <br />4.194.1974 n`v. 9.90'9 Suoeseacs 4.949.19'x'4 0ev. 134'113 <br />
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