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EJ3RAS-KA- <br />Good Life. C-ree: Ser,ice. <br />NE Sec of State - Robert B. Entree <br />Filing Document #: 2106000219-3 Pages: 1 <br />Debtor Name: OSVALDO RIGONDEAUX-CUADRA <br />Filing Date and Time: 06/04/2021 09:29 AM <br />Notice of State Tax Lien <br />202104 771 <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 />94006717 <br />Federal ID Number <br />Lien Serial Number <br />12174409 <br />Lien Filed With: <br />Social Security Number <br />XXX -XX -2777 <br />Spouses Socia{ Security Number. <br />® Register of Deeds ■ County Clerk <br />Date of Lien <br />June 01, 2021 <br />lien Typo: <br />®Original ❑Continuation El Corrected <br />County <br />HALL <br />Business Name and Location Address <br />Taxpayer Name and Mailing Address <br />OSVALDO RIGONDEAUX-CUADRA <br />109 E CHARLES ST <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 />2019 <br />12/18/2020 <br />$566.00 <br />$45.08 <br />$20.17 <br />631.25 <br />Total <br />$631.25 <br />Sign <br />I certify that the Nebraska Department of Revenue has compied with the laws of the Stale of Nebraska in determining the amount shown to De due,'._ <br />and that the taxpayer has failed to pay the amount due after demand. This Notice of State Tax Lien is an effective lien and serves to Continue the priority of <br />the Slates interest in the elected property of the taxpayer. <br />here Prepare, s Signature <br />Revenue Senior Agent <br />Tale <br />Revenue Supervisor <br />06/01/2021 (402171-4339 <br />Cale Phone Number <br />06/01/2021 <br />rwthorized Signaltjre Title Date <br />4-494-t9?4 Few 1)-2Ctit Supemnedes 4-94&1974 Ran'. e•2o'3 <br />