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Nt nee of state - Konen N. tvnen <br />Filing Document #: 2005000643-8 Pages: 1 <br />Debtor Name GABE COIN <br />Filing Date and Time: 05/19/2020 09:29 AM <br />1 <br />NEBRASKA <br />Notice of State Tax Lien <br />.14,401,4•114, NVIIN. <br />202003230 <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 Tien or continuation statement. <br />PLEASE 00 NOT WRITE IN THIS SPACE <br />Nebraska ID Number <br />97705012 <br />Federal ID Number <br />Lien Serial Number <br />12054310 <br />Lien Filed With: <br />® Register o1 Deeds County Clerk <br />Social Security Number <br />XXX -XX -8945 <br />Spouses Social Security Number <br />XXX -XX -3903 <br />Date of L:en <br />May 11, 2020 <br />Lien Type. <br />® Original <br />Continuation <br />❑ Cprrected <br />County <br />HALL <br />Business Name and Location Address <br />Taxpayer Name and Mailing Address <br />GABE COIN <br />KILEY GOSDA <br />2212 WOODRIDGE LANE <br />GRAND ISLAND NE 68801 <br />Tax Program <br />Tax Period <br />Date of <br />Assessment <br />1 <br />I <br />Tax ( <br />1 <br />Penalty <br />Interest <br />Costs <br />Total Due <br />Individual <br />2018 <br />10/30/2019 <br />1 <br />$2,294.001 <br />$114.70 <br />$123.18 <br />2,531.88 <br />Total <br />$2,531.88 <br />I certify that the Nebraska Department o1 Resee0e hes complied with the Taws of the State of Nebraska ,n determining the amount shown to be due. <br />and that the taxpayer has faded lo pay the amount duo after demand. This Noltee of State Tax Lien is an effective Gen and serves to conlm::e the priority of <br />Me Stales interest in the affected property of the taxpayer. <br />sign <br />here Preparer's *mature <br />15019orized Signatpm <br />Revenue Agent <br />Title <br />Revenue Supervisor <br />05/11/2020 _{402)471-6043 <br />Cale Phone Number <br />05/11/2020 <br />Title <br />Oat <br />e-494 +'4,4 Pew. 0-20'9 Scee-serles 4.249-1274 nev.5-2013 <br />