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N_J <br />Good Great Se•vcr. <br />202103953 <br />NE Sec of State - Robert B. Evnen <br />Filing Document #: 2105000462-4 Pages: 1 <br />Debtor Name: JUAN SARMIENTO SOTELO <br />Filing Date and Time: 05/11/2021 10:07 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 DO NOT WRITE IN THIS SPACE <br />Nebraska ID Number <br />95500847 <br />Federal ID Number <br />Lien Serial Number <br />12173358 <br />Liam Filed With. <br />® Register of Deeds ❑ County clerk <br />Social Security Number <br />XXX -XX -4668 <br />Spouse's Social Security Number <br />Dale of Lien <br />May 05, 2021 <br />Lien Type: <br />® Original 0Conlinuation ❑Corrected <br />County <br />HALL <br />Business Name and Location Address <br />Taxpayer Name and Mailing Address <br />JUAN SARMIENTO SOTELO <br />1524 COVENTY LANE <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 />2017 <br />11/23/2019 <br />$141.00 <br />$81.85 <br />$123.51 <br />346.36 <br />Individual <br />2018 <br />11/23/2019 <br />$375.00 <br />$18.75 <br />$36.01 <br />429.76 <br />Total <br />$776.12 <br />sign <br />here <br />I certify that the Nebraska Department of Revenue hes complied with the abs of the Stale at Nebraska In determining the amount ahOwn to be due, <br />and that the taxpayer has ailed to pay tee amount due after demand. ibis Nance of State fan Lien is an eeective ken and serves to continue the prkaity of <br />the Sale's interest in the affected property of the taxpayer. <br />Prepay <br />ye Sigma <br />Z/. / fU. <br />Zed �+ <br />Revenue Agent <br />05/05/2021 (402)471-5833 <br />Ties Date Phone Number <br />Revenue Supervisor 05/05/2021 <br />Title Date <br />4494.1974 Pav 62018 Summed 4.949.1974 Pee 62013 <br />