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N EBRA:4K,A rw..r.r rw xr.r.r., 202010058 NE Sec of State - Robert B. Evnen Filing Document #: 2012000924-0 Pages: 1 Debtor Name: FRANK GOMEZ Filing Date and Time: 12/22/2020 10:07 AM Notice of State Tax Lien This Notice Of State Tax Lien is issued by the Nebraska Department of Revenue for unpaid taxes administered by the Tax Commissioner. Taxes, including penalties, interest, and costs, which are shown below, are due from the taxpayer and remain unpaid after demand.These taxes are a lien for all property located in the county and rights to property owned by the taxpayer or acquired before the expiration of this lien.This lien will expire and become unenforceable 10 years after the date of recording if no continuation statement is recorded on or prior to the expiration of the previous lien or continuation statement. PLEASE DO NOT WRITE IN THIS SPACE Nebraska ID Number 40398862 Federal D Number L,mo Serial Number 12066759 t mn Filed With: Social Security Number XXX -XX -4127 Spouse's Social Security Number ® Register of Deeds • County Clerk Dab of Lien December 17, 2020 Lien Type. ®oregmal 0Continuation EjCorrected County HALL ress Taxpayer Name and Mailing Address FRANK GOMEZ 211 CHEROKEE AVE GRAND ISLAND NE 68803 Tax Program Tax Period Date of Assessment Tax Penalty Interest Costs Total Due Individual 2017 08/23/2019 $1,392.00 $69.60 $169.35 1,630.95 Total $1,630.95 I certify that the Nebraska Department of Revenue has comped with the laws 01 the State of Nebraska in determining the amount shown b be due. and that the taxpayer has laded to pay the amount due after demand. This Notee 01 Stab Tax Lien is an etledrve Yen and serves to continue the priority of Me Slate's interest in the affected property of the luryayer. hsign,Revenue Agent 12/17/2020 (402)471-5712 erePreparr's Sign m lure Title Dale Phone Number rami ,.,ut/,, Revenue Supervisor 12/17/2020 Auth*yeod Signature Title Date 4-494.1974 lbv. 0.20'6 %memories e.949.1974 O. 6.2013