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LQ' <br />N_EB� <br />.,� LG. ',.',v <br />NE Sec of State - Robert ri. tvnen <br />Filing Document #: 2006001319-0 Pages: 1 <br />Debtor Name: ANTONE E ROUNDY <br />Filing Date and Time: 06/30/2020 11:02 AM <br />Notice of State Tax Lien <br />20200 41q <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 />Nebraska ID Number <br />45703876 <br />PLEASE RETURN TO: <br />NEBRASKA DEPT OF REVENUE <br />PO BOX 94609 <br />LINCOLN NE 68509-4609 <br />Federal D Number <br />Lien Serial Number <br />12057138 <br />Date of Lien <br />June 25, 2020 <br />Lien Filed With. <br />® Register of Deeds LI County Clerk <br />Social Security <br />XXX -XX -96 <br />Lien Type: <br />®Original <br />0 Continuation <br />D Corr <br />Business Name and Location Address <br />Number Spouse's Social Security Number <br />16 XXX -XX -2745 <br />County <br />ecTea HALL <br />Taxpayer Name and Mailing Address <br />ANTONE E ROUNDY <br />NICOLE A ROUNDY <br />509 W 8TH ST <br />GRAND ISLAND NE 68801-4227 <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 />2017 <br />05/23/2018 <br />$2,292.00 <br />$144.09 <br />$219.15 <br />2,655.24 <br />Individual <br />2018 <br />05/07/2019 <br />$2,861.00 <br />$188.05 <br />$171.27 <br />3,220.32 <br />Total <br />$5,875.56 <br />I certify that The Nebraska Department of Revenue has conipkod with the laws of the State of Nebraska in determining the amount shown to be due, <br />and that the taxpayer has failed to pay the amount due after demand. This Notice of State Tax Lien is en effective lien and serves to continue the poority of <br />the Slate's interest in the affected property of the taxpayer. <br />sign <br />here spa <br />A�n+e4i:� <br />Revenue Agent 06/25/2020 (308)632-1208 <br />Title Date Phone Number <br />Revenue Supervisor 06/25/2020 <br />Title Dale <br />4a94.19T4 Pee. 8-20'6 Suwooers 4-940-1974 Pea_ 8-2013 <br />