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NEB. -KA <br />c cd<,-;rea,serv,r* <br />02035 <br />NE Sec of State - Robert B. Evnen <br />Filing Document #: 2004000119-7 Pages: 1 <br />Debtor Name: SHARI L HORN <br />Filing Date and Time: 04/02/2020 09:20 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 Iien.This Ilan will expire and <br />become unenforceable 10 years after the date of recording H 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 />Nehresia ID Number <br />44384556 <br />Federal ID Number <br />Lien Serial Number <br />12051461 <br />lien Flied Watt ' <br />Social Security Number <br />XXX -XX -8464 <br />Spouse's Social Security Number <br />® Register of Deeds El County Clerk <br />Date of lien <br />March 25, 2020 <br />Lien Type: <br />®Original ❑continuation 0conocted <br />County <br />HALL <br />Business Name and Location Address <br />Taxpayer Name and Malting Address <br />SHARI L HORN <br />2216 W JOHN <br />GRAND ISLAND NE 68803 <br />Tax Program <br />Tax Period <br />Date of <br />Assessment <br />Tax <br />1 Penalty <br />Interest <br />Costs <br />Total Due <br />Individual <br />2011 <br />06/17/2017 <br />$8,176.00 <br />$2,044.00 <br />$2267.56 <br />12,487.56 <br />Total <br />$12,487.56 <br />I certify that the Nebraska Department of Revenue hes complied with Mie laws of the State of Nebraska in determining the amount shown 03 be due <br />and trial the taxpayer hes failed to pay Me amount due alter demand. This Notice of State Tax Lien is an effect.* lien and serves to continue the priority of <br />the State's interest. in the affected .. operty of the taxpayer, <br />sign <br />here r�r <br />Authori2 <br />nalUfe <br />Revenue Agent 03/25/2020 (308)632-1203 <br />Title Dale Phone Number <br />Revenue Supervisor 03/25/2020 <br />Tee Date <br />4-494-1974 Pax 8-20'8 Supersedes 4-949-1074 Roy^ 8.2013 <br />