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N,Ect- . <br />NE Sec of State - Robert B. Evnen <br />Filing Document #: 2004000753-5 Pages: 1 <br />Debtor Name: JEFFERY C GREEN <br />Filing Date and Time: 04/17/2020 09:52 AM <br />20200237€ <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 IR Nur <br />97648310 <br />Federal ID Nu <br />Len Serial Nuatter <br />12052341 <br />Lien Filed With: <br />Register 0 Deeds © County C <br />social Security Num! <br />XXX -XX -4556 <br />Spouse Social Security Number <br />Date of Ler <br />April 09, 2020 <br />Len Type; <br />Orgotal f Conitnuatwn Conecsed <br />County <br />HALL <br />Business Name and Location Address <br />Taxpayer Name and Mailing Address <br />JEFFERY C GREEN <br />2020 COTTAGE <br />GRAND ISLAND NE 68803 <br />Tax Program <br />I <br />I <br />Tax Period <br />Date of <br />Assessment <br />Tax <br />Penalty <br />Interest <br />Costs <br />Total Due <br />Individual <br />( <br />2017 <br />07/06/2018 <br />$295.001 <br />$14 75 <br />$25.10 <br />334.85 <br />Total <br />$334.85 <br />sign <br />here <br />I certify that the Nebraska Department of venue has complied wftn the laws of the State of Nebraska a determining the amount shown to be due. <br />and that the taxpayer has failed to pay the amount rare after demand. Thos Notice of State Tax lien is an affective hen and serves to continue the p%nnty of <br />the States interest at the elected properly of the taxpayer, <br />Revenue Agent 04/09/2020 (308)632-120a <br />Title Date Phone Number <br />Revenue Supervisor 04/09/2020 <br />ignal re ". Title <br />Onto <br />4.444 -Isle Rev, 5. Ste Supersedes 449.9!974 fad. &2015 <br />