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N.E1 A&E <br />Good Lo`e. Grow Se•r.. . <br />202010262 <br />NE Sec of State - Robert B. Evnen <br />Filing Document #: 2012001236-9 Pages: 1 <br />Debtor Name: DEBORAH A MERRICK <br />Filing Date and Time: 12/30/2020 10'15 AM <br />PLEASE RETURN TO: <br />NEBRASKA DEPT OF REVENUE <br />PO BOX 94609 <br />LINCOLN NE 68509-4609 <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 Tex <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 00 NOT WRITE IN THIS SPACE <br />Nebraska ID Number <br />35744871 <br />Federal ID Number <br />Lan Senal Number <br />12066790 <br />Lien Filed With: <br />Social Security Number <br />XXX -XX -2323 <br />Spouse's Social Security Number <br />i7 Reyisler of Deeds IIS County Clerk <br />Date of Lien <br />December 17, 2020 <br />t <br />Lien Type: <br />❑Corrected <br />County <br />HALL <br />LI Original IN Continuation <br />us nese Name and Location Address <br />Taxpayer Name and Mailing Address <br />DEBORAH A MERRICK <br />10711 E 24TH ST S <br />INDEPENDENCE MO 64052 <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 />05/10/2019 <br />5984.00 <br />$246.00 <br />$117.68 <br />1,347.68 <br />Individual <br />2018 <br />04/15/2019 <br />$.00 <br />$25.09 <br />$.00 <br />25.09 <br />Total <br />$1,372.77 <br />I certify that the Nebraska Department of Revenue has complied with the laws of the State of Nebraska in do ermitn9 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 Yen and serves to commie the prosy of <br />the Slate's interest in the affected property at the taxpayer. <br />sign <br />here �P��s <br />nature <br />thG . <br />Authonied Signature <br />Revenue Agent 12/17/2020 (402)370-3121 <br />Tale Date Phone Number <br />Revenue Supervisor 12/17/2020 <br />Tine Date <br />•.91.1974 Rev. 15-2010 Supersedes 4424& 1974 kin.. 8-2013 <br />