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PLEASE RETURN TO: <br />NEBRASKA DEPT OF REVENUE <br />PO BOX 94609 <br />LINCOLN NE 68509-4609 <br />N_FBRrSI- <br />_fa. _.,ra• <br />_ <br />202001126 <br />NE Six of State - Robert B. Evnen <br />Filing Document #: 2002000771-3 Pages: 1 <br />Debtor Name: JASON C LAWHORNE <br />Filing Date and Time: 02/19/2020 09:57 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 />Nebraska ID Number <br />32870477 <br />Feoerel D Number <br />Lien Serial Number <br />12048599 <br />Lien Filed With: <br />® Register of Deeds 0 County Clerk <br />Social Security Number <br />XXX -XX -0229 <br />Spouse's Social Security Number <br />Date of Oren <br />February 10, 2020 <br />Lien Type <br />®Onpmat ❑ Continuation ❑ Corrected <br />County <br />HALL <br />Business Name and Location Address <br />Taxpayer Name and Mailing Address <br />JASON C LAWHORNE <br />339 SOUTH OAK STREET <br />GRAND ISLAND NE 68801 <br />Tax Program <br />Tax Period <br />Date of <br />Assessment <br />Tax <br />Penalty <br />Interest <br />Costs <br />Total Due <br />Individual <br />2013 <br />12/14/2019 <br />$9.831.00 <br />52,457.75 <br />51.937.38 <br />14,226.13 <br />Individual <br />2014 <br />12/14/2019 <br />53.882.00 <br />$970.50 <br />5648.56 <br />5,501.06 <br />Total <br />$19,727.19 <br />sign <br />here <br />I certify that Ara - • - r, tie has complied with the laws of the State of Nebraska in deermimrtg the amount shown to be due, <br />and that Webs he ! e pay t amount due after demand. This Noticed Stats Tax Llen is an etlectrve ken and serves to continue the priority 01 <br />the Stale'- tare t .. .:...... = taxpayer. <br />Authorized Signature <br />Revenue Agent 02/10/2020 (308)632-1210 <br />Title Data Phone Number <br />Revenue Supervisor 02/10/2020 <br />Trtb Date <br />4-494'974 Rev. e -701a SopersMen 4949•'974 Rev. 62013 <br />