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PLEASE RETURN TO: <br />NEBRASKA DEPT OF REVENUE <br />PO BOX 94609 <br />LINCOLN NE 68509-4609 <br />NEB,. <br />C,xxf Lae. Great Serrce. <br />202101788 <br />NE Sec of State - Robert B. Evnen <br />Filing Document #: 2103000207-1 <br />Debtor Name: ROBERT C GARCIA JR <br />Filing Date and Time: 03/03/2021 11:42 AM <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 />29785626 <br />Federal ID Number <br />Oen Serie) Number <br />12169532 <br />Leon Filed With : <br />Social Security Number <br />XXX -XX -8802 <br />Spouses Soaal Security Number <br />i7 Register of Deeds ■ County Clerk <br />Dale of Leon <br />February 23, 2021 <br />Leon Type: <br />® Original ❑Continuation ❑Corracbed <br />County <br />HALL <br />Business Name and Location Address <br />axpayer Name and Manmg Address <br />ROBERT C GARCIA JR <br />2015 N HUSTON AVE <br />GRAND ISLAND NE 68801-7965 <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 />11/23/2019 <br />$982.00 <br />$49.10 <br />$153.14 <br />1,184.24 <br />Individual <br />2017 <br />11/23/2019 <br />$1,960.00 <br />$98.00 <br />$246.85 <br />2,304.85 <br />Individual <br />2018 <br />11/23/2019 <br />$1,041.00 <br />$52.05 <br />$93.89 <br />1,186.94 <br />Total <br />$4,676.03 <br />I certify that the Nebraska Department of Revenue has complied with the laws of the State of Nebraska in determining doe amount shown to be due <br />and that the taxpayer has fated to pay the amount due after demand. This Notice of Stale Tax Lien is an elective lion and serves to continue the priority of <br />the Stab's interest In the seeded properly of the taxpayer. <br />Revenue Agent 02/23/2021 (3081632-1208 <br />Title Date Phone Number <br />Revenue Supervisor 02/23/2021 <br />Tide Date <br />4404.197.4 2109 6.2016 Soberness 4449.194 nk'r. 6-2013 <br />