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Good Ltfe. Great Service. <br />wast_ aarwuc <br />202102388 <br />NE Sec of State - Robert B. Evnen <br />Filing Document #: 2103001107-9 Pages: 1 <br />Debtor Name: TAM H NGUYEN <br />Filing Date and Time: 03/23/2021 09:44 AM <br />J <br />Notice of State Tax Lien <br />This Notice of State Tax Uen 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 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 />• <br />Nebraska ID Number <br />36241873 <br />Federal ID Number <br />Lien Serial Number <br />12065786 <br />lien Filed With: <br />Sodel Security Numbs r <br />))(.)(4123 <br />Spouses Sochi Security Number <br />® Register of Deeds ■ County Clerk <br />Date of Lien <br />November 23, 2020 <br />Lien Type: <br />$424.70 <br />$21.90 <br />County <br />HALL <br />® original II Continuation <br />■ Corrected <br />Business Name and Location Address <br />axpayer Name and Matting Address <br />TAM H NGUYEN <br />721 W STOLLEY PARK RD <br />GRAND ISLAND NE 68801 <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 />2015 <br />01/26/2019 <br />$424.70 <br />$21.90 <br />$76.51 <br />523.11 <br />Individual <br />2016 <br />12/29/2018 <br />$156.00 <br />$7,80 <br />$22.82 <br />186.62 <br />Total <br />$709.73 <br />I certify that the Nebraska Department of Revenue has complied with the laws of the State of Nebraska In determining the amount shown to be due, <br />and that the taxpayer has felled to pay the amount due after demand.Thls Notice of State Tax Lien is en effective lien and serves to continue the priority of <br />the State's interest in the enacted property of the taxpayer. <br />sign <br />here ° mare SgnaIore <br />thorned Signet <br />Revenue Anent <br />Tile <br />Revenue Supervisor <br />11/23/2020 (402)471-5712 <br />Date Phone Number <br />11/23/2020 <br />Title <br />Date <br />4-494-i974 Ser. t-2ole SupoaaoM 4-149-1074 Reg. 8.2013 <br />