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NEBRASKA - <br />Good Lite. Coen:- Swv.;:e. <br />omr*.w.r w r.uws <br />202101626 <br />NE Sec of State - Robert B. Evnen <br />Filing Document #: 2102001142-3 Pages: 1 <br />Debtor Name: DANIEL R LENON <br />Filing Date and Time: 02/26/2021 09:26 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 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 />98709623 <br />Federal ID Number <br />Lien Serial Number <br />12169426 <br />Lien Fled With: <br />® Rugoter oI Deeds D County Clerk <br />Social Security Number <br />XXX -XX -0339 <br />Spouses Social Security Number <br />XXX -XX -0008 <br />Dab of Lien <br />February 22, 2021 <br />Lien type. <br />07/06/2018 <br />$.00 <br />County <br />HALL <br />® original • Continuation <br />■ Corrected <br />Business Name and Location Address <br />Taxpayer Name and Mailing Address <br />DANIEL R LENON <br />TEDDI WILSON LENON <br />3771 MONARCH AVE <br />GRAND ISLAND NE 68803 <br />Tax Program <br />Tax Period <br />Date of <br />Assessment <br />Tax <br />Penalty <br />Interest <br />Costs <br />Total Due <br />Individual <br />2016 <br />07/06/2018 <br />$.00 <br />$.00 <br />$187.08 <br />187.08 <br />Individual <br />2018 <br />11/0112019 <br />$1,763.00 <br />$477.99 <br />$158.86 <br />2,399.85 <br />Total <br />$2,586.93 <br />I certify that the Nebraska Department of Revenue has complied with the lass of the State of Nebraska In determining the amount shown lobe due. <br />and that the taxpayer has rased to pay the amount due alter demand. This Notice of State Tax Lien is an elective lien and serves to continue the priority Cl <br />the State's interest in the alecled property of the taxpayer. <br />sign <br />here' Preparers Signature <br />Authorized Siglrature <br />Revenue Agent 02/22/2021 (402)471-5712 <br />Trtia Date Phone Number <br />Revenue Supervisor 02/22/2021 <br />Title Date <br />4.4t4.t97s Rev. 6.2016 Supersedes 4.249-1974 the. 6-2013 <br />