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NE Sea of State - Robed B. Evnen <br />Filing Document #: 2005000724-2 Pages: 1 <br />Debtor Name: ROBERTO HERNANDEZ MONTANO <br />Filing Dale and Time: 05/22/2020 09:02 AM <br />Notice of State Tax Lien <br />.8.1410.14041 1111-V<MA <br />202003344 <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 />94639663 <br />Federal ID Number <br />t.len Serial Numbe• <br />12064768 <br />_en Filed Wittt: <br />56 Fester al Detain Q County Ctert, <br />Sre iat Seeanty Number <br />XXX -XX -9619 <br />SWaase's Bridal Securily Number <br />Date a` I. en <br />May 18, 2020 <br />-en Type. <br />pci Cngtnal Dcortaruailcn ❑Corrected <br />County <br />HALL <br />Business Name and Location Address Taxpayer Name and Mailing Address <br />ROBERTO HERNANDEZ MONTANO <br />1004 W 3RD ST <br />GRAND ISLAND NE 68801 <br />Tax Program <br />Tax Period Date of <br />Assessment <br />Tax 1 Penalty <br />Interest <br />S35.26 <br />Costs <br />Total Due 1 <br />444.76] <br />Individual <br />2017 08103/2018 <br />$390.00 $19.50 <br />Total <br />444. <br />sign <br />here <br />t cortity that the NoLraska Depart rot 01 Neve tan complied wan eve laws of Iter State of Nebraska in determining the amount sures to be One, <br />and riot the taxpayer 1186 tailed la .. li,e an'raunt <. after demand.': hs Nal-ce D7 Save lax Len in en effective i en and serve& to eantirJe the briotly of <br />the States trrtereat <br />Preparer <br />Au. ed <br />Revenue bl05/18/2020 (308)632-1203 <br />1 ale Y Cate Phone Number <br />Revenue Supervisor 05/18/2020 <br />Title Date <br />4-424. 19,i ger. B-2ai' a lGpement, 4 uvea 12', <br />