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NEBRASKA. <br />w..r+r a•...wra <br />202100376 <br />NE Sec of State - Robert B. Evnen <br />Filing Document #: 2101000580-3 Pages: 1 <br />Debtor Name: JUAREZ REPARACIONES <br />Filing Date and Time: 01/14/2021 09:02 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 Ilen.Thls 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 MIS SPACE <br />Date of <br />Asaesslncnt <br />Nebraska ID Number <br />12604364 <br />Federal <br />0 Numbs* <br />/(4 .1L 1. <br />/6.A/£ <br />Lien Serial Number <br />12066060 <br />Lien Fps Valk <br />IKI Register 01 Dotes 0 County CIeea <br />Social Security Number <br />XXX XX -5790 <br />Spouse's Socia Securly Mcan er <br />Date rd Lien <br />December 1, 2020 <br />Lien Type: <br />® Original 0Contnuation 0Coneeted <br />County <br />HALL <br />.00 <br />usiness Name and Location Address <br />Taxpayer Name and Melling Address <br />JUAREZ REPARACIONFS <br />608 N VINE STREET <br />GRAND ISLAND NE 68801 <br />ERVIN JUAREZ <br />608 N VINE STREET <br />GRAND ISLAND NE 68801 <br />Tax Program <br />1 <br />Tax Period <br />Date of <br />Asaesslncnt <br />Tax <br />Penalty <br />Interest <br />Costs <br />Total Due <br />Sales <br />10/101;2017 - 12/31'2017 <br />12.'09/2019 <br />475.00 <br />95.00 <br />59.9 <br />.00 <br />629.09 <br />Saks <br />01/01'2018 .03/31i2018 <br />12:09/2019 _ <br />475.00 <br />95.00 <br />55.53 <br />.00 <br />625.53 <br />Total <br />1,254.67 <br />wale that M Nebreaka Dsparimenl d WMnue Ras complied with era rams Gillet SW► a feseresra In deewminiq bre amain atiown to be due. <br />and het the taxpayer rue Weed a pay IM amount doe air eemem. Tree Nonce of State tie Lien A en oaedinS fen end revues to wove tie priority of <br />bre Scares rawest n eta adeced property Mine teepayer <br />here' ��eo sprawl* <br />!�rl1 r/4/4 <br />Autnorirrd Sq+ilure <br />Revenue Acca' <br />12/01/2020 402-471-5723 <br />rale Dee Phone Number <br />Revenue Senior Agent 12/01/2020 <br />tee <br />Dale <br />a-cN. 1971 Itw. Site. 56moetan a.sa4PON nen. 4403 <br />