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PLEASE RETURN TO: <br />NEBRASKA DEPT OF REVENUE <br />PO BOX 94609 <br />LINCOLN NE 68509-4609 <br />Liocd L:'e. C•eal Serv:c.e. <br />.e..ar+rr OF erw.aw <br />202009790 <br />NE Sec of State - Robert B. Evnen <br />Filing Document #: 2012000513-8 Pages: 1 <br />Debtor Name: RICHARD W RUKAVINA <br />Filing Date and Time: 12/11/2020 10:26 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 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 aY Tres SPACE <br />Nebraska ID Number <br />93823800 <br />Federal ID Number <br />Lien Serial Number <br />12066254 <br />Lien Filed With: <br />® Register of Deeds ❑ County Clerk <br />Social Security Number <br />XXX -XX -9553 <br />Spouses Social Security Number <br />XXX -XX -7155 <br />Date of Lien <br />December 03, 2020 <br />Lien Type: <br />❑Conecled <br />County <br />HALL <br />® original ■ Continuation <br />usiness Name and Location Address <br />Taxpayer Name and Mailing Address <br />RICHARD W RUKAVINA <br />NELLIE F RUKAVINA <br />1063 HAVEN VIEW DR <br />0 FALLON MO 63366 <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 />2018 <br />05/03/2019 <br />$557.00 <br />$27.85 <br />$45.63 <br />630.48 <br />Total <br />$630.48 <br />I certify that the Nebraska Department of Revenue hes complied with the laws of the Stab of Nebraska in determining the amount shown lobe due, <br />and that the taxpayer has tailed to pay the amount due alter demand. This Notice of Stale Tax Lien is an elective Yen and serves to continue the parity of <br />the State's interest in the effected property of the taxpayer. <br />sign <br />here spa . S j-pr'tyj(t-retre /`\ & l& <br />aAhO Signe ure l G <br />Revenue Agent 12/03/2020 (402)370-3121 <br />TeteDab Phone Number <br />Revenue c -tvQrz fart w. 12/03/2020 <br />Title Q Dale <br />4.1841874 Rev 6.2018 Supersede 4 49.197e hes 84013 <br />