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J� <br />G:otl tire,.reat San.�c <br />NE Sec of State - Robert B. Evnen <br />Filing Document #: 2109000076-7 Pages: I <br />Debtor Name: RAUL MELESIO JR <br />Filing Date and Time: 09/01/2021 11:53 AM <br />Notice of State Tax Lien <br />202107503 <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 />Nebrasta ID Number <br />94786860 <br />Foderat D Number <br />Lien Serial Number 1 Lien Plod With: <br />12179126 ? ®Register 01 00000 C aunty Clerk <br />Social Security Number <br />XXX -XX -8319 <br />Spouse's Social Security Nun,Ler <br />Date et ..on Lien Type <br />August 20, 2021 i ®Crignal EContnuation ❑Caseated <br />County <br />HALL <br />Business Name and Location Address <br />Taxpayer Name and Mailing Address <br />RAUL MELESIO JR <br />518 E CAPITAL AVE APT 61 <br />GRAND ISLAND NE 68801 <br />Tax Program <br />Tax Period <br />Date of <br />Assessment <br />Tax I Penalty <br />1 <br />Interest <br />Costs <br />Total Due <br />Individual <br />2018 <br />10/30/2019 <br />$372.001 $221.00 <br />$58.37 <br />651.37 <br />Total <br />$651.37 <br />I certify that the Nebraska Department of Revenue has complied with the laws of the State of Nebraska in determining the amount shown lo be due, <br />and Mat the uorpay0r has laded to pay the amount doe after demand. This Notice of State Tax Lien is an effective lien and serves 10 continue the priority of <br />the Slate's else est ir: Ore ;leaded property 01 Ma taxpayer. <br />sign <br />here • Preparers :e <br />Aut.: ed gnaturo <br />Revenue Agent 08/20/2021 (308)632-1208 <br />Title Date Phone Number <br />Revenue Supervisor 08/20/2021 <br />Title Date <br />a -49a-1074 Pee. 0.2016 Supersedes 4.9a9.1$1a Rev. 8-2C13 <br />