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202101127 <br />NE Sec of State - Robert B. Evnen <br />Filing Document #: 2102000338-1 Pages: 1 <br />Debtor Name: JOHN C GAY <br />Filing Date and Time: 02/09/2021 09:33 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 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 Iien.This filen 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 WAITE IN THIS SPACE <br />Nebraska ID Number <br />96052961 <br />Lien Snn-i�al dumber <br />12168289 <br />February 01, 2021 <br />Fit] Register et're'eds <br />yn Type: <br />ij j Oegmal <br />al D Mar <br />Business Name and Location Address <br />Taxpayer Name and Mailing Address <br />JOHN C GAY <br />1007 KERMIT DRIVE APT 10 <br />KNOXVILLE IA 50138 <br />Tax Program <br />! <br />Tax Period <br />Date of <br />Assessment <br />Tax <br />Penalty <br />Interest <br />Costs <br />Total Due <br />Individual <br />2015 <br />12/17/2018 <br />5252.00 <br />$93.75 <br />$280.42 <br />626.17 <br />Total! <br />$626.17 <br />sign <br />here <br />I cerl:ty that the Nebraska pe <br />esti that the taxaayer has tailed & <br />the States rHa.est yi 100 a1evied <br />mend or Revert* has cos ted a TO the fags 01 the State of Nebraska firs ¢etas rims( <br />y 109 amount use ate? demand. This Native el Stale Tax I. it an e{hMttore inptx incl <br />arty est 1: te saxpayor. <br />Revenue Accent <br />7,11.3 <br />Revenue Supervisor <br />02/01/2021 (308)632-1210 <br />Phare Number <br />02/01/2021 <br />Daus <br />444a4•t974 %tev.8OGta Segffesedes 4 -gag: tore /fix 9-7/v-3 <br />awe <br />nee <br />