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NFBRAS 4A- <br />G.x�r. Life. Co,,r: Siery Jr. <br />OtMJ+wrW P NV.. <br />Nb Sec of State - Kobert B. bvnen <br />Filing Document #: 2006001318-1 <br />Debtor Name: JUNIOR COBAS RAMIREZ <br />Filing Date and Time: 06/30/2020 11:00 AM <br />Pages: 1 <br />Notice of State Tax Lien <br />202004489 <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 />47928697 <br />Federal ID Number <br />Penalty <br />Lien Serial Number <br />12056974 <br />Len Filed With: <br />® Register of Deeds C] County Clerk <br />Social Security Number <br />XXX -XX -0737 <br />Individual <br />Spouse's Social Security Number <br />Dale of Lien <br />June 24, 2020 <br />Lien Type, <br />El Corrected <br />$90.47 <br />County <br />HALL <br />I Original 0Continuation <br />Business Name and Location Address <br />axpayer Name and Mailing Address <br />JUNIOR COBAS RAMIREZ <br />1103W6TH <br />GRAND ISLAND NE 68801 <br />Tax Program <br />Tax Period <br />Date of <br />Assessment <br />Tax <br />Penalty <br />Interest <br />Costs <br />Total Due <br />Individual <br />2016 <br />11/23/2019 <br />$721.00 <br />$36.05 <br />$90.47 <br />847.52 <br />Individual <br />2017 <br />11/23/2019 <br />$440.00 <br />$22.00 <br />$42.01 <br />504.01 <br />Individual <br />2018 <br />11/23/2019 <br />$164.00 <br />$8.20 <br />$9.79 <br />181.99 <br />Total <br />$1,533.52 <br />sign <br />here <br />I certify that the Nebraska Department of Revenue has complied with the laws of the State of Nebraska in determining the amount shown to be due. <br />and that the taxpayer .. failed to pay the amount due after demand. This Notice o1 State Tax Lien is an effective lien and serves to conkrwe the priority of <br />the State's interest in : affected pro rty of the taxpayer. <br />Revenue Agent 06/24/2020 (308)632-1210 <br />Title Date Phone Number <br />Revenue Supervisor 06/24/2020 <br />Title Date <br />4-494-1974 Rev. 112018 Supersedes 4-949.1974 Rev 8-2013 <br />