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(,o:d ldu. great _ <br />se..x..w.e uvu,. <br />202001843 <br />NE Sec of State - Robert B. Evnen <br />Filing Document #: 2003001364-3 Pages: 1 <br />Debtor Name: PATRICK GOODRICH <br />Filing Date and Time: 03/24/2020 10:23 AM <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 DO NOT WRITE IN THIS SPACE <br />Nebraska ID Number <br />20877900 <br />Federal 0 Number <br />Len Serial Number <br />12050928 <br />Dale of Lien <br />Lien Flied With: <br />® Register of Deeds [J County Clerk <br />Social Security Number <br />XXX -XX -1750 <br />Spouse's Social Security Number <br />March 13, 2020 <br />Lien Type: <br />® Original ❑ Continuation Q Corrected <br />County <br />HALL <br />Business Name and Location Address <br />Taxpayer Name and Mailing Address <br />PATRICK GOODRICH <br />PO BOX 50 <br />GRAND ISLAND NE 68802-0050 <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 />2010 <br />06/26/2017 <br />$567.22 <br />$141.81 <br />$184.82 <br />893.85 <br />Individual <br />2011 <br />06/26/2017 <br />$2,487.89 <br />$621.97 <br />$685.91 <br />3,795.77 <br />Individual <br />2012 <br />06/26/2017 <br />$1,538.92 <br />$384.73 <br />$356.19 <br />2,279.84 <br />Total <br />$6,969.46 <br />I certify that the Nebraska Department of Revenue has compiled with the laws of the State of Nebraska in determining the amount shown to be due, <br />and that the taxpayer has tailed to pay the amount due after demand. This Notice of State Tax Lien is an effective lien and serves to continue the priority of <br />the State's Interest m the alluded properly of the taxpayer. <br />Revenue Agent 03/13/2020 (308)632-1203 <br />Tide Date Phone Number <br />Revenue Supervisor 03/13/2020 <br />Title Dale <br />4-494.,97. am. e•20,e Supersades 4.049.1074 Wv. 620.3 <br />