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nt Sec of state - Konen Is. tvnen <br />Filing Document #: 2005000641-0 <br />Debtor Name: GEORGE R SEDLACEK <br />Filing Date and Time: 05/19/2020 09:23 AM <br />Pages: I <br />Notice of State Tax Lien <br />2020C 3228 <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 />15096769 <br />Federal 0 Number <br />Len Senal Number <br />12054608 <br />Lien Filed Weh. <br />Social Security Number <br />XXX -XX -6925 <br />Spouses Social Security Number <br />XXX -XX -2567 <br />® Register cf Deeds ■ County Clerk <br />Date o+ Lion <br />May 14, 2020 <br />t <br />Lam Type. <br />®original 0Comnuatlon 0Corrected <br />County <br />HALL <br />usiness Name and Location Address <br />Taxpayer Name and Mailing Address <br />GEORGE R SEDLACEK <br />DONNA R SEDLACEK <br />1817 SOUTH CURTIS STREET <br />GRAND ISLAND NE 68803 <br />Tax Program <br />Tax Period Date of <br />Assessment <br />Tax I Penalty <br />Interest <br />Costs <br />Total Due <br />Individual <br />2016 11/16/2018 <br />$11,712.001 $2,928.00 <br />$1,403.84 <br />16,043.84 <br />Total <br />$16,043.84 <br />I certify that the Nebraska Department • Revenue has complied with the laws of the State o1 Nebraska In determining the amount shown to be due. <br />and that the taxpayer has . to pay the . mount due atter demand. This Notice or Sate Tax Lien .5 an effective ken and serves to cont nue the priority of <br />the States axer. in thu a .. pro. jj of the taxpayer. <br />• <br />sign110 <br />here Preparer's <br />9n <br />Revenue05/14/2020 (308)632-1203 <br />T Ido Date Phone Number <br />05/14/2020 <br />Revenue Supervisor <br />Tib Date <br />x1961974 Rev. 8.20•'9 Sr.pe•sedes a-009.1974 nee. a-200 <br />