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Good Lite (/rear Service. <br />0414611,411M 01, OISVPROY <br />NE Sec of State - Robert B. Evnen <br />Filing Document #: 2108000611-5 Pages: 1 <br />Debtor Name: VINCENT T MENDEZ <br />Filing Date and Time: 08/11/2021 10:39 AM <br />Notice of State Tax Lien <br />202106888 <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 Ilen.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 IN THIS SPACE <br />Nebraska ID Number <br />13408496 <br />Federal D Number <br />821268132 <br />Lien Serial Number <br />12103480 <br />Lien Filed With: <br />Social Security Number <br />XXX -XX -5058 <br />Spouse's Social Security Number <br />p Register of Deeds I! County Clerk <br />Date of Lien <br />August 2, 2021 <br />Lien Type: <br />® Original []Continuation ElCorrected <br />County <br />HALL <br />usiness Name and Location Address <br />Taxpayer Name and Mailing Address <br />VINCENT T MENDEZ <br />D/B/A MENDEZ ENTERPRISES <br />2404 WEST LINCOLN HWY <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 />Sales <br />07/01/2019 - 12/31/2019 <br />07/25/2020 <br />200.00 <br />70.00 <br />14.22 <br />.00 <br />284.22 <br />Total <br />284.22 <br />I certify that the Nebraska Department of Revenue hes complied with the laws of the Stale of Nebraska in determining the amount shown to be due. <br />and that the taxpayer has failed to pay the amount due atter demand. This Notice of State Tax Lien Is an effective Non and serves to continue the priority of <br />the State's interest in the effected property of the taxpayer. <br />Sign 1 feeedraCia, £ / 24 2 , 4 Z . Revenue Aeent <br />here Preure <br />Authorized Signature <br />Title <br />Revenue Senior Agent <br />08/05/2021 402-471-5717 <br />Date <br />Phone Number <br />8-5-21 <br />Title Date <br />4.4941974 Rev 11-2018 Saponadea 4.949.1974 RN. 52013 <br />