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NEBRASKA <br />.1,ero;,.e...,.F. <br />60,11.111. <br />202007361 <br />NE Sec of State - Robert B. Evnen <br />Filing Document #: 2009001425-7 Pages: 1 <br />Debtor Name: DANGER J MEDINA FAURE <br />Filing Date and Time: 09/29/2020 11:13 AM <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 Tien 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 Tien or continuation statement. <br />PLEASE 00 NOT WRITE INTHIS SPACE <br />Nebraska IO Number <br />95391738 <br />Federal ID Number <br />Lien Serial Number <br />12062392 <br />Lien Filed With: <br />Social Security Number <br />XXX -XX -5992 <br />Spouse's Social Security Number <br />® Register of Deeds 1 County Clerk <br />Dale of Lien <br />September 25, 2020 <br />Lien Type. <br />$1,631.00 <br />$81.55 <br />County <br />HALL <br />® own.' NI Continuation <br />■ Corrected <br />Business Name and Location Address <br />Taxpayer Name and Mailing Address <br />DANGER J MEDINA FAURE <br />930 S EDDY ST <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 />10/08/2019 <br />$1,631.00 <br />$81.55 <br />$176.51 <br />1,889.06 <br />Individual <br />2018 <br />10/08/2019 <br />$501.00 <br />$25.05 <br />$36.31 <br />562.36 <br />Total <br />82,451.42 <br />sign <br />here <br />I certify that Me Nebraska Department of Revenue has complied with the we of the Stale of Nebraska m 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 an effective lien and serves to continue the priority o1 <br />OW State's interest in the atbcled property ol the taxpayer. <br />Preparers Sgnature <br />ihorixed Signal;re <br />Revenue Senior Agent 09/25/2020 (402)471-4339 <br />Tide Dab Phone Number <br />Revenue Supervisor 09/25/2020 <br />Title <br />Date <br />tw94.1974 Roc 64010 Supenadoa 4440.1070 Rev 5.013 <br />