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PLEASE RETURN TO: <br />NEBRASKA DEPT OF REVENUE <br />PO BOX 94609 <br />LINCOLN NE 68509-4609 <br />Goc d L re. Great Sery se. <br />x.1.1xv4.10 <br />202009916 <br />NE Sec of State - Robert B. Evnen <br />Filing Document #: 2012000740-0 Pages: 1 <br />Debtor Name: JAMES 0 FRANCIS <br />Filing Date and Time: 12/16/2020 10:07 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 ars 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 INTHIS SPACE <br />Ngbraek8 10 Number <br />91900433 <br />Federal <br />0 Number <br />Lien Serial Nu mbtN <br />12066611 <br />Lien Flied With: <br />Sodal Security Number <br />XXX -XX -1618 <br />Spouse's Social Security Number <br />XXX -XX -2518 <br />Da Flatlifile, of Deeds ■ Cc.IntY Clerk <br />Dale d Lien <br />December 10, 2020 <br />t <br />Lien Type: <br />® Original ❑conanoanon <br />$447.25 <br />County <br />HALL <br />• Conecled <br />usiness Nams and Location Address <br />Taxpayer Name and Melling Address <br />JAMES 0 FRANCIS <br />MICHELE D FRANCIS <br />900 BUFORD BLVD <br />FREDERICKTOWN MO 63645 <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 />05/03/2019 <br />$1,777.00 <br />$447.25 <br />$210.81 <br />2,435.06 <br />Total <br />$2,435.06 <br />1 unify that the Nebraska Oeparnnant o1 Rexene has complied with the laws of the state o1 Nebraska In determining the amount shown to be due. <br />and Mat the taxpayer has tailed to pay the amount due *tier demand. This Notice 01 Stale Tax Lien is an ellaghe lien and larvas to continue the priority of <br />the Slates interest ir, the seeded property of IM taxpayer, <br />sign <br />here r Proparer <br />nails <br />Authorized Signature Tate <br />Revenue Agent <br />Title <br />Revenue <br />Jl <br />12/10/2020 (402)370-3121 <br />Date Phone Number <br />12/10/2020 <br />Date <br />44044974 Rae 8-7018 Sapresedas 4.945.1974 Rio 10-2013 <br />