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60 0:1 Ure. Great Service. <br />q.Y.M1n M *MOM. <br />202104650 <br />NE Sec of State - Robert B. Evnen <br />Filing Document #: 2106000012-2 Pages: 1 <br />Debtor Name: NICK TERJAK <br />Filing Date and Time: 06/01/2021 10:12 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 />13462881 <br />Federal 0 Number <br />No FEIN <br />Uen Serial Number <br />12102243 <br />Lien Filed With: <br />Social Security Number <br />XXX -XX -5974 <br />Spouses Social Security Number <br />XXX -XX -8874 <br />© Register of Deeds al County Clerk <br />Date of Uen <br />May 20, 2021 <br />Lien Type: <br />ElCorrected <br />County <br />HALL <br />Ki Original 1111 Continuation <br />Business Name and Location Address <br />Taxpayer Name and Mailing Address <br />NICK TERJAK <br />TMP SERVICES <br />1036 SOUTH LINCOLN <br />HASTINGS NE 68901 <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 />04/01'2020 - 09/30/2020 <br />02/06/2021 <br />750.00 <br />206.25 <br />19.63 <br />.00 <br />975.88 <br />Total <br />975.88 <br />I certify that the Nebraska Department of Revenue has complied with the laws of the Stab of Nebraska in determining the amount shown b be due, <br />and thel the taxpayer has tailed to pay the amount due after demand. This Notice of State Tax Uen is an effective Hen and serves to continue the priority of <br />the Stales Interest in the affected property of the taxpayer. <br />sign�j,(yf yTh <br />here error'signat n Title <br />Date Phren Number <br />�.� Revenue Senior Agent 05/24/2021 <br />Authorized lure Title <br />Revenue Agent <br />05/13/2021 402-471-6067 <br />Dale <br />4.194.1974 Rev, 0.2010 Suponedef 4.949.1074 Raw. 84013 <br />