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ea, <br />PLEASE RETURN TO: <br />NEBRASKA DEPT OF REVENUE <br />PO BOX 94609 <br />LINCOLN NE 68509-4609 <br />NEBRAsKA- <br />iarod Lr'e Q. -eat Se -vice <br />202010261 <br />NE Sec of State - Robert B. Evnen <br />Filing Document #: 2012001235-0 Pages: 1 <br />Debtor Name: EDWIN A LICONA <br />Filing Date and Time: 12/30/2020 09:42 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 />us- <br />PLEASE DO NOT WRITE IN THIS SPACE <br />Nebraska ID Number <br />99955970 <br />Federal D Number <br />Lien Serial Number <br />12066886 <br />Len Filed With: <br />® Register of Deeds 0 County Clerk <br />Social Security Number <br />XXX -XX -5229 <br />Spouse's Social Security Number <br />Date of Lien <br />December 22, 2020 <br />t <br />Lien Type: <br />® original 0Continuation 0Corrected <br />County <br />HALL <br />nese Nems and Location Address <br />Taxpayer Name and Mailing Address <br />EDWIN A LICONA <br />812W16THST <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 />2016 <br />09/15/2019 <br />$609.00 <br />$45.05 <br />$125.24 <br />779.29 <br />Total <br />$779.29 <br />I certify that the Nebraska Department at Revenue has complied with the laws of the Stale of Nebraska in determining the amount Mown to be due. <br />and that the taxpayer has tailed to pay the amount due alter demand. This Notice of State Tax Lien ie an effective hen and serves to continue the priority of <br />the Stale's interest in the affected property of the taxpayer. <br />sign <br />here r Iheparera L <br />Autn0fized are <br />Revenue Agent 12/22/2020 (308)632-1203 <br />Tale Dale Phone Number <br />Revenue Supervisor 12/22/2020 <br />Title Date <br />A -494-197e Rev. 5-20,5 Sure reee4 4449-1974 Floe 84013 <br />