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N.EE3R-A-rs-KA-- <br />Iris>U L?'f•.:ii eA' <br />Of ArVI.J. <br />NE Sec of State - Robert B. Evnen <br />Filing Document #: 2004001379-4 Pages: 1 <br />Debtor Name: JESUS FLORES SERVIN <br />Filing Date and Time: 04/28/2020 10:22 AM <br />Notice of State Tax Lien <br />20200200 <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 />PLEASE RETURN TO: <br />NEBRASKA DEPT OF REVENUE <br />PO BOX 94609 <br />LINCOLN NE 68509-4609 <br />Nebraska ID Number <br />40167283 <br />Federal IU Number <br />Len Serra' Number <br />12053235 <br />Date of Lien <br />April 23, 2020 <br />I Lien Filed With' <br />® Respsler Cl Deeds Q Coolly clerk <br />t :.:en Type: <br />I( ;M Org:na'G)r,trrr:at on <br />Business Name and Location Address <br />Social Security Number <br />XXX -XX -6706 <br />Spouses Sacra; Security Number <br />County <br />QCorrectod HALL <br />Taxpayer Name and Mailing Address <br />JESUS FLORES SERVIN <br />1627 S SYLVAN ST <br />GRAND ISLAND NE 68801 <br />Tax Program <br />t <br />Tax Period <br />Date of <br />Assessment <br />Tax j <br />l <br />Penalty <br />. Interest <br />Costs <br />Total Due <br />Individual <br />2016 <br />06/01/2018 <br />$231.00 <br />$57.75 <br />$27.02 <br />315.77 <br />Total <br />$315.77 <br />sign <br />here <br />I certify Phut the Ne raska Department 1 Revenue has comp! <br />and that the taxpayer has ail d to pay i =. amount cue after dente <br />the Stales interest4eytt _ . ix I rite taxpayer. <br />Preparers Sg <br />Authorized <br />Ire laws bl lIre State of Nebraska in determining the amount shown to be due. <br />Tics Notice of State lac Lien a an effective lien and serves to coni wa rise priority of <br />Revenue �>tr 04/23/2020 (308)632-1210 <br />Ti?l0 <br />DAIS Phone N:lnrber <br />Revenue Supervisor 04/23/2020 <br />Title <br />Date <br />4-194.,974 :Irv. same asioursakis 4449, ".°,4 Rer, 820,:3 <br />