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Gr,:w r. <br />202104699 <br />NE Sec of State - Robert B. Evnen <br />Filing Document #: 2106000074-2 Pages: 1 <br />Debtor Name: MARIANO RIQUIAC <br />Filing Date and Time: 06/02/2021 09:38 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 00 NOT WRITE' INTHIS SPACE <br />- <br />Nebraska ID Num ber <br />47266279 <br />Federal D Number <br />Lien Serial Number <br />12174179 <br />Lien Filed With: <br />Social Security Number <br />XXX -XX -3264 <br />Spouse's Social Security Number <br />X mister of Deeds • County Clark <br />Date of Lien <br />May 25, 2021 <br />ben Type: <br />J Original []Continuation E)Corrected <br />County <br />HALL <br />Business Name and Location Address <br />Taxpayer Name and Mallin <br />Address <br />MARIANO RIQUIAC <br />617W5TH ST <br />GRAND ISLAND NE 68801 <br />Tax Program <br />' <br />Tax Period <br />Date of <br />Assessment <br />( <br />t <br />Tax <br />Penalty <br />Interest <br />Costs <br />Total Due <br />Individual <br />2019 <br />i 07/31/2020 <br />' <br />$1,893.00 <br />$127.17! $66.38 <br />2,086.55 <br />Total $2,086.55 <br />I certify that the Nebraska Department of Benne has complied with the laws of the State at Nebraska in determining the amount shown to be due, <br />and that the taxpayer has faired to pxp the amount due after demand. This Notice of State Tax Lien is an effective lien and serves to Continue the priority of <br />the State's interest in t - affected property of the taxpayer. <br />sign a SitzC (Af Revenue Agent 05/25/2021 _1308)632-1208 <br />here Prepare( S j&e h �J J Idle Date Phone Number <br />(,,�-P� Revenue Supervisor 05/25/2021 <br />Authorized Signature 11--11 Tide Dale <br />4.494-1974 be... 8-20'8 Supe neiten 4449' 974 Pay. [-2013 <br />