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N_EBR-A& (.v.:<, _ fr ..rest peralirNMIIIT OP ON VIONE 202104457 NE Sec of State - Robert B. Evnen Filing Document #: 2105001241-0 Pages: 1 Debtor Name: ROBERTO J HERNANDEZ CUADOT Filing Date and Time: 05/26/2021 01:06 PM Notice of State Tax Lien This Notice of State Tax Lien is issued by the Nebraska Department of Revenue for unpaid taxes administered by the Tax Commissioner. Taxes, including penalties, interest, and costs, which are shown below, are due from the taxpayer and remain unpaid after demand.These taxes are a lien for all property located in the county and rights to property owned by the taxpayer or acquired before the expiration of this IIen.This Tien will expire and become unenforceable 10 years after the data of recording if no continuation statement is recorded on or prior to the expiration of the previous lien or continuation statement. PLEASE DO NOT WRITE IN THIS SPACE Nebraska ID Number 94719721 Federal ID Number Lien Serial Number 12173958 Lien Filed With: ® Register of Deeds ❑ County clerk Social Security Nunr0er XXX -XX -4132 Spouse's Sopa) Securely Number Date of Len May 19, 2021 Lien Type: ® Orig nal ❑ Continuation ❑ Corrected County HALL us nese Name and Location Address Taxpayer Name and Mailing Address ROBERTO J HERNANDEZ CUADOT 1004 W 3RD STREET GRAND ISLAND NE 68801 Tax Program Tax Period Date of Assessment Tax Penalty Interest Costs Total Due Individual 2017 11/23/2019 $1,152.00 $57.60 $153.13 1,362.73 Individual 2018 11/23/2019 $829.00 $41.45 980.56 951.01 Total $2,313.74 sign here Nebraska Depar ent of Revenue has complied with the laws of the State of Nebraska In determining the amount shown as perdue. has failed tamount due eller demand. This Notice of State Tax Len is an effective ken and carves to conte the priority 01 true affected .. rty 01 the taxpayer. rer's Sq w Authorized pnatnx �IA M ' / Revenue Agent Tyre Revenue Supervisor (308)632-1210 Phone Number 05/19/2021 Tide Data 4.194•t974 Rev. 8.20111 Summed* 44114/97s FMv. b2ons