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NEBRASKA-, <br />(.oJ Lire. Great`,e'rw <br />0.4111.40 iluitYrieta <br />NE Sec of State - Robert B. Evnen <br />Filing Document #: 2004000328-3 Pages: 1 <br />Debtor Name: JESUS ARREOLA ANIMA <br />Filing Date and Time: 04/07/2020 09:46 AM <br />202002133_ <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 Tien for all property located <br />in the county and rights to property owned by the taxpayer or <br />acquired before the expiration of this tien.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 ID Number <br />47757078 <br />Federal O Number <br />Lien Serial Number <br />12051832 <br />Date of Lien <br />April 01, 2020 <br />L <br />ben Filed With: <br />:6J Register o1 Deeds ❑ County Clerk <br />Sobel Security Number <br />XXX -XX -7967 <br />L en Type: <br />Original ❑ Continuation u Corrected <br />Business Name and Location Address <br />Spouse's Social Security Number <br />ICounty <br />(HALL <br />Taxpayer Name and Mailing Address <br />JESUS ARREOLA ANIMA <br />518 E CAPITAL AVE TRL 21 <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 />2016 <br />05/30/2017 <br />8376.00 <br />$18.80 <br />$42.85 <br />437.65 <br />Total <br />$437.65 <br />I certify that the Nebraska Department of Revenue has complied win the laws of the State of Nebraska in determining the amount shown to be due, <br />and that the taxpayer has failed to pay the amount duo after demand. This Notice of Slate Tax Lien 0 an effective ten and serves to continue the priority of <br />Ole State's interest in the affected property ol the taxpayer. <br />Revenue Agent <br />Title <br />Revenue Supervisor <br />04/01/2020 (308)632-1203 <br />Date Phone Number <br />04/01/2020 <br />Title Date <br />4.494-+974 Rev./1.20'e Supersede{ 4-949-19?4 Rov. 0-2013 <br />