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NE Sec of State - Robert B. Evnen <br />Filing Document #: 2008000895-6 Pages: I <br />Debtor Name: JOSE A CHAVEZ RODRIGUEZ <br />Filing Date and Time: 08/25/2020 I I:46 AM <br />Notice of State Tax Lien <br />orreove <br />202006313 <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 />Nebrasw In Nve txsr <br />48421820 <br />deral D Number <br />Liars Serial Nurnbet <br />12060046 <br />Date of Lien <br />August 18, 2020 <br />L <br />Lien Fled With: <br />® r'ft3+y`tunr W Conan n County Clerk <br />Lien Type. <br />X Original ❑ Continuation <br />Business Name and Location Address <br />Social Secutity Number <br />XXX -XX -1262 <br />Spouses Social Sscr;uxy Number <br />Ej Cot facie d <br />County <br />`HALL <br />Taxpayer Name and Mailing Address <br />JOSE A CHAVEZ RODRIGUEZ <br />635 KENNEDY DR APT 3 <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 />2012 <br />10/27/2019 <br />$162.00 <br />$40.50 <br />$41.00 <br />243.50 <br />Individual <br />2013 <br />10/27/2019 <br />$690.00 <br />$172.50 <br />$153.94 <br />1,016.44 <br />Individual 2014 <br />10/27/2019 <br />$118.00 <br />S29.50 <br />$22.79 <br />170.29 <br />Total <br />$1.430.23 <br />sign <br />here <br />I certify that the Nebraska De:,arment of Revenue has comoliod mob the laws of the State of Nebraska in <br />an* that the taxpayer has failed to ptiy the amount due ale, demand. This Notice of Stare lar t..ten is an effects <br />the Slates interest in the aflecied pr aserty of the taxpayer. <br />--tom j1 <br />Revenue Agent <br />Tale <br />Revenue Supervisor <br />are t rt <br />rmining the amount shown to be due. <br />an aro stases to continue the pr only of <br />08/18/2020 3308)632-1203 <br />Phone Number <br />08/18/2020 <br />Date <br />Dale <br />1-4n4-tgre Rev. 0 -?0'0 S.ieetseciza 4.aa9.197a 4e, 0-2013 <br />