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N_EBRA-SFEA-, <br />NE Sec of State - Robert B. Evnen <br />Filing Document #: 2107001462-9 Pages: 1 <br />Debtor Name: JORGE A BATISTA GUJIERREZ <br />Filing Date and Time: 07/23/2021 01'52 PM <br />Notice of State Tax Lien <br />202106276 <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 area 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 />Nebrasvt ID Number <br />92386687 <br />:.fan Serial Number <br />12176566 <br />!Federal ID Number <br />i <br />Lien Filed With; { Social Security Number <br />® Register of Deeds ❑ County Clerk XXX -XX -0109 <br />Spouses Social Security Number <br />Date of Lien <br />July 15, 2021 <br />Lien Type: <br />E Original Contirwaticn C Cor <br />L__ Business Name and Location Address <br />County <br />Corrected <br />HALL <br />Taxpayer Name and Mailing Address <br />JORGE A BATISTA GUTIERREZ <br />208 E 8TH ST <br />GRAND ISLAND NE 68801 <br />Tax Program Tax Period <br />Date of <br />Assessment <br />Tax <br />Penalty <br />Interest <br />Costs <br />Total Due <br />Individual 2018 <br />12/10/2019 <br />$1,327.00 <br />$66.35 <br />$135.17 <br />1,528.52 <br />Total <br />$1,528.52 <br />I certify Mat the Nebraska Department of Revenue has complied with the laws of the State of Nebraska In determining the amount shown to be due. <br />and that the taxpayer has failed to pay the amount clue after demand. This Notice of State Tax Lien is an effective lien and serves to continue the priority of <br />the Slate's interest in, the affected property of the taxpayer. <br />signk-/'Ajita, Sc�ce 44.D <br />here r Preparer s S�, lure <br />lure <br />Revenue Agent 07/15/2021 (402)471-5833 <br />Title Date Phone Number <br />Revenue Supervisor 07/15/2021 <br />Tale Date <br />d.d94 r97d em. a -Zine Si perr+de$ d.9a9.1974 Vier. 8-9013 <br />