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Gaud L'r' Creat to vice. <br />20210694 <br />NE Sec of State - Robert B. Evnen <br />Filing Document #: 2108000778-9 Pages: 1 <br />Debtor Name: JOSE T GARCIA <br />Filing Date and Time: 08/13/2021 10:16 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 />99982609 <br />Federal ID Number <br />Lien Serial Number <br />12178414 <br />Lien Filed Wrth: <br />Social Security Number <br />)p()( -XX -5174 <br />Spouse's Social Security Number <br />® Register of Deeds • County Clerk <br />Dale of Lien <br />August 11, 2021 <br />Lien Type: <br />❑Corrected <br />Canty <br />HALL <br />f Original ❑Continuation <br />Business Name and Location Address <br />Taxpayer Name and Mailing Address <br />JOSE T GARCIA <br />1414 SAINT PAUL RD APT 81 <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 />2016 <br />11/16/2019 <br />$606.00 <br />$54.85 <br />$180.86 <br />841.71 <br />Individual <br />2018 <br />11/16/2019 <br />$406.00 <br />$20.30 <br />$42.26 <br />468.56 <br />Total <br />$1,310.27 <br />sign <br />here <br />I candy that the Nebraska Department of Revenue hes complied with the laws of the Stale of Nebraska in daterrmmg ate amount shown to be due, <br />and at the taxpayer has failed to pay the amount due after demand. This Waco of State Tax Lien 1s an effective ken and serves to continue the priority of <br />tea Interest le the aeected property of the taxpayer. <br />Revenue Agent 08/11/2021 <br />Title <br />rer's Signet <br />Date <br />Revenue Supervisor <br />mired Signature Title <br />(402)471-6043 <br />Phone Number <br />08/11/2021 <br />Dab <br />4494.1974 Rev. 11.20111 Supersedes eeset971 RM. 6-2013 <br />