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NEBRASKA <br />Lire <br />OP.40.11-wir <br />NE Sec of State - Robert B. Evnen <br />Filing Document #: 2102000099-5 Pages: 1 <br />Debtor Name: JOSE SERRANO <br />Filing Date and Time: 02/02/2021 09:44 AM <br />Notice of State Tax Lien <br />2 0 210 0 9 05 <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 00 NOT WRITE IN THIS SPACE <br />'Vetaraska to Number <br />91173205 <br />Lien Serial Number <br />12167929 <br />Date 01 Lien <br />January 25, 2021 <br />L <br />Federal la Number <br />I en Feed Wsiti: <br />M Register al Drees <br />Lien Type, <br />Original <br />C] County Clerk <br />1:1 Continuation <br />Social Sesairity Number <br />XXX -XX -8589 <br />Connoted <br />Sea SOndltt Security Number <br />county <br />HALL <br />Business Name and Location Address <br />Taxpayer Name and Mailing Address <br />JOSE SERRANO <br />2755 0 FLANNAGAN ST <br />GRAND ISLAND NE 68803 <br />Tax Program <br />Tax Period <br />Date of Tax <br />Penalty I Interest <br />Costs Total Due <br />Assessment <br />Individual <br />2017 <br />10/31/2018 <br />$1,359.00 <br />$101.60 . $222.50 <br />1,683.10-, <br />Individual <br />2015 <br />09/03/2019 <br />$214.00 <br />$10.70 $18.79 <br />243.49. <br />sign <br />here <br />Total <br />$1,926 59] <br />I certify that 1Re Nenfasaa Reeculmont at Revenue has complied WO the laws of the State of tedbfasifa 0 detearining the amount shown to be eve, <br />and that tee taxpayer has felled to pay the amount due after Oemand. This Notice a State Tort Lam is an effective Len and carves to continue the priority at <br />Itto Stale's interest or the affected property 01 the tan,sy0, <br />Revenue Agent 01/25/2021 (308)632-1206 <br />, <br />Preparers Signature . l'itle (:)0(4 Phone Number <br />(;.:.„-,-- .,' :1, ,/, -..--- - - ' " '," <br />TR:venue Supervisor 01/25/2021 <br />wised Signature <br />ir atm- 'LYN ns-2cift Superstileta41 <br />Rn', 9.1R7.1 /ev 154e,1 <br />