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N_EflRAr&KA- <br />n> <br />202004744 <br />NE Sec of State - Robert B. Evnen <br />Filing Document #: 2007000344-8 <br />Debtor Name: PEDRO E PEREZ ALVAREZ <br />Filing Date and Time: 07/08/2020 09:38 AM <br />Pages: 1 <br />Notice of State Tax Lien <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 Iien.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 />Nska ID Number <br />94079382 <br />Federal ID Number <br />Lien Serial Number <br />12057377 <br />Lien Filed With: <br />® Registe, cl Deeds ❑ County Clear <br />Social Security Number <br />XXX -XX -0850 <br />Spouses Social Security Number <br />Date of Lien <br />June 30, 2020 <br />Len Type: <br />❑Corrected <br />County <br />HALL <br />® Original • Continuation <br />Business Name and Location Address <br />Taxpayer Name and Mailing Address <br />PEDRO E PEREZ ALVAREZ <br />327 E SOUTH STREET <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 />2017 <br />05/23/2018 <br />$1,966.00 <br />$109.30 <br />$189.33 <br />2,264.63 <br />Total <br />$2,264.63 <br />I certify that the Nebraska Department of Revenue has complied with the laws of the State of Nebraska to determining the amount shown to be due <br />and mat me taxpayer has 'aped to pay the amount due aIle, demand Ttss Notice of Stale Tax Lien 5 an eaective Fen and serves to conl.nue the priority o1 <br />the States interest in the affected pr, .erty of the taxpayer. <br />Revenue Agent 06/30/2020 (308)632-1208 <br />Tale Date Phone Number <br />Revenue Supervisor 06/30/2020 <br />Title Date <br />4-04,971 Rev11-20113 saperserlex 4-94.19la 11ev S.7V 3 <br />