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PLEASE RETURN TO: <br />NEBRASKA DEPT OF REVENUE <br />PO BOX 94609 <br />LINCOLN NE 68509-4609 <br />N - <br />(sX41 ure. L• ,,Z Sa^.ice. <br />202002034 <br />NE See of State - Robert B. Evnen <br />Filing Document #: 2004000148-9 Pages: 1 <br />Debtor Name: PHILIP C SLOAT <br />Filing Date and Time: 04/02/2020 10:52 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 atter 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 10 Number <br />37798324 <br />Federal 10 Number <br />Lien Serial Number <br />12051565 <br />Len Filed With: <br />Social Security Number <br />XXX -XX -4740 <br />Spouses Social Security Number <br />XXX -XX -8739 <br />® Register of Deeds ■ County Cie rk <br />Dale of Len <br />March 26, 2020 <br />Lien Type: <br />$75.50 <br />County <br />HALL <br />LI Original 0Continuation <br />♦♦Corrected <br />Business Name and Location Address <br />Taxpayer Name and Mailing Address <br />PHILIP C SLOAT <br />KELLY SLOAT <br />1202 K STREET <br />FRANKLIN NE 68939 <br />Tax Program 1 Tax Period <br />Date of <br />Assessment <br />Tax <br />Penalty <br />Interest <br />Costs <br />Total Due <br />Individual 1 2017 <br />11/30/2018 <br />$908.00 <br />$45.40 <br />$75.50 <br />1,028.90 <br />Individual 1 2018 <br />10/30/2019 <br />$1,113.00 <br />$77.65 <br />$52.75 <br />1,243.40 <br />Total <br />$2,272.30 <br />sign <br />here <br />I certify the N - .r. I. Depanme 01 Revenue has compheel with the laws of the State of Nebraska in determining the amount shown 83 be due. <br />and that thel sed to pay : amount due after demand. This Notice of State Tax Lien is an effective len and serves to continue the priority of <br />the Stale%" •r•_i1 :: fleeted . •n•. .. the taxpayer. <br />Ail j/ Revenue Agent <br />I're. �.L Al/I"' <br />Tie <br />Revenue Supervisor <br />1 <br />Auttwrix 'gn: ure <br />03/26/2020 (308)632-1210 <br />Date Phone Number <br />03/26/2020 <br />Title Date <br />4-a94.1874 Rev. 6.2018 S:.pewodes 4.949.1974 Rev, 8.7013 <br />