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Far.R ^ r.�A <br />K� <br />Filing Date and Time: 01/11/2021 08:56 AM <br />20210025 <br />-4 <br />NE Sec of State - Robert B. Evnen <br />Filing Document #: 2101000268 <br />Debtor Name: YERATAIN PEREZ BARRIOS <br />Pages: 1 <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 IN THIS SPACE <br />Nebraska ID Number <br />12872261 <br />Federal D Number' <br />Lien Serial Nam bm <br />12066964 <br />Lien Pikttl Wstfe. <br />[ Reg stat of ueaas Q Ccurty Cerk <br />Social Security Namber <br />XXX -XX -3465 <br />Spouses Social Security Number <br />Date 01 Lien <br />January 5, 2021 <br />Lien Type: <br />® Criytr,ai El Coratnwatkm 0Corrected <br />County <br />HALL <br />usiness Name and Location Address <br />Taxpayer Name and Mailing Address <br />YERAT AIN PEREZ BARRIOS <br />122 E 14TH ST <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 />Withholding <br />0401:2018 - 12/31'2018 <br />08124!20 l9 <br />267.06 <br />115.50 <br />31.82 <br />.00 <br />414.38 <br />Total <br />414.38 <br />I certify that the Nebraska Depattment of Revenue nas co npkod with the lawn of the State of Nebraska in determinate the amount shown to be due. <br />and teat the taxpayer has fated to pay the amount duo atter demand. Thin Notice of State Tax Lieut is an effective lien and serves to cont es° the priority Ot <br />the States interest in the affected property of trio taxpayer, <br />sign I) Revenue Agent 12/30/2020 402-471-5788 <br />here P,e{7aror'a Siytwtme Title Cala Pttorw Number <br />Revenue Senior Agent 1-5-2021 <br />Authpszpo Signature lite Date <br />,kek Iota nay 6,70,9 San:meets 4.00tt tett net. 6.2C13 <br />