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N-EBR,S44A-- <br />uC.Y, 5•ea <br />2020052 <br />NE Sec of State - Robert B. Evnen <br />Filing Document #: 2007000977-0 <br />Debtor Name: SHANA MARIE TUXHORN <br />Filing Date and Time: 07/23/2020 10:50 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 />Nebraska ID Number <br />12465771 <br />Fedora) ID Number <br />811187535 <br />Lien Serial Number <br />12058374 <br />Lien Fled With. <br />Social Security Number <br />XXX -XX -5840 <br />Spouses Social Security Number <br />ri, Register of Deeds • County Clerk <br />Date 01 Lien <br />July 24, 2020 <br />Lien Type: <br />13,702.80 <br />3,443.48 <br />County <br />HALL <br />© original • Cont,nuaton <br />al Corrected <br />Business Name and Location Address <br />Taxpayer Name and Mailing Address <br />SHANA MARIE TUXHORN <br />317W4TH S'f <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 />Sales <br />05/01/2018 - 12/31'2019 <br />04/20/2020 <br />13,702.80 <br />3,443.48 <br />1,213.64 <br />.00 <br />18,359.92 <br />Withholding <br />04101/2018 - 06/30/2018 <br />12:01/2018 <br />50.15 <br />113.00 <br />10.09 <br />.00 <br />173.24 <br />Withholding <br />07/01/2018 - 09/3012018 <br />02/27/2019 <br />644.34 <br />128.87 <br />50.44 <br />.00 <br />823.65 <br />Withholding <br />10/01/2018 - 12/31/2018 <br />0227/2019 <br />550.98 <br />27.55 <br />38.02 <br />.00 <br />616.55 <br />Total <br />19,973.36 <br />1 certify that the Nebraska Department of Revenue has complied with the laws of the State of Nebraska in OMermining the amount shown to be duo. <br />and that the taxpayer has tailed to pay the amount clue atter demand. This Notice of State Tax Lien is an effective hen and serves to cent,nue the pnorey of <br />the Cs interest i ecIed property of hie taxpayer. <br />sign a, <br />here rPref e <br />Authorized <br />Revenue Senior Agent <br />Tele <br />Revenue Senior Agent <br />07/17/2020 <br />Date <br />402-471-5709 <br />Pte Nu er <br />7/7 Zozo <br />Title Date <br />4.494.1974 Rev. 8-2015 Supersedes 4.949.1974 Rev. 8-2013 <br />