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boos t e3' Rf^^>G2 <br />NE Sec of State - Robert B. Evnen <br />Filing Document #: 2003001131-7 Pages: 1 <br />Debtor Name: URIEL SANDOVAL CHAVIRA <br />Filing Date and Time: 03/19/2020 12:28 PM <br />202001712- <br />PLEASE <br />0200 X12 <br />PLEASE RETURN TO: <br />NEBRASKA DEPT OF REVENUE <br />PO BOX 94609 <br />LINCOLN NE 68509-4609 <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 00 NOT WRITE IN THIS SPACE <br />Nebraska 1D Number <br />47626097 <br />Federal ID Number <br />Tax <br />Lion Serial Number <br />12050877 <br />L:en FiIod With: <br />(J neg;ster til Deeds ❑ Ctunty Chia, <br />Social Security Number <br />XXX -XX -3206 <br />t Spouse's Social Security Number <br />i <br />Date el Len <br />March 13, 2020 <br />Len Typo: <br />® Original ❑ Curn-mualio Corrected <br />1 County <br />;HALL <br />Business Name and L <br />cation Address <br />Taxpayer Name and Mailing Address <br />ORIEL SANDOVAL CHAVIRA <br />3106 W 13TH ST <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 />[ <br />2013 <br />09/24/2017 <br />5733.00 <br />536.65 <br />5147.67 <br />917.32 <br />Total <br />$917.32 <br />sign <br />here <br />I certify that the Nob <br />and that the taxpayer ha <br />the State's interest in the <br />e has camp8etf Beath tha latus of 114r State of Netennt a is deter nin 7100 amount <br />e after de=nao,d, Thin Kariba of State Tax Lien is an effective Yren and serves to c <br />yet. <br />Ay o1 <br />Revenue Agent 03/13/2020 (308)632-1203 <br />Tale Date Phone Number <br />Revenue Supervisor 03/13/2020 <br />Title Dote <br />9-494-1974 nes 8.8018 Saye neAea a-e4s-1y7, RA: E4013 <br />