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NEBRA&KA- <br />Gaud Liie, Great Senece. <br />NE Sec of State - Robert B. Evnen <br />Filing Document #: 2103001531-2 Pages: 1 <br />Debtor Name: ROSA M PORTILLO <br />Filing Date and Time: 03/30/2021 10:10 AM <br />Notice of State Tax Len <br />2,02102608 <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 area 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 />Date of <br />Assessment <br />Nebree a to Number <br />12513466 <br />Fedetat ID Number <br />811806628 <br />Interest <br />Lien Serial Number <br />12170243 <br />Len Filed With <br />N Rego. of Deed. O co i y Grant <br />Social Security Number <br />XXX -XX -7529 <br />Spouse's Social Security Number <br />04/08/2018 <br />Dele of Lien <br />March 15, 2021 <br />Lien Type: <br />202.68 <br />.00 <br />County <br />HALL <br />1 <br />® Original ■ Continuation <br />■ Coed <br />Business Name and Location Address <br />axpeyer Name and Maufng A0Wress <br />ROSA M PORTILLO <br />EL BUEN SABOR <br />111 W 13TH STREET <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 />Withholding <br />01/01/2017- 12/31/2017 <br />04/08/2018 <br />1,397.61 <br />350.06 <br />202.68 <br />.00 <br />1,950.35 <br />Withholding <br />01101/2018 - 03131/2020 <br />0812912020 <br />3,960.00 <br />1,320.00 <br />343.94 <br />.00 <br />5,623.94 <br />Total <br />7,57429 <br />certify that the Nebraska Department of Rooms has complied with the taws of the Stab of Nebraska 1n Oewmk*ng the amount shown to be due, <br />and that the la has failed b pay the amount due after demand. net Notice of Slap Tat Lhn is an elective Men and seine to continue the priority 01 <br />Iha/SIaWs <br />Otero chs electedty of the aspayet. <br />Revenue Agent 03/09/2021 402-471-5956 <br />Tide Dar <br />Revenue Senior Agent 3727177..OL <br />Tide Date <br />44104-14X Pov. 04010 Supetseaat 1-940.1974 RNt 84013 <br />