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Coed Life. Gieat Ser v <br />202107683 <br />NE Sec of State - Robert B. Evnen <br />Filing Document #: 2109000508-1 Pages: 1 <br />Debtor Name: MELISSA DE LEON <br />Filing Date and Time: 09/09/2021 09:53 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 SI THIS SPACE <br />Nebraska ID Number <br />43438520 <br />Federal ID Number <br />Lien Serial Number <br />12179639 <br />Lien Filed With: <br />® Register of Deeds ❑ Cour+y clerk <br />Social Security Number <br />XXX -XX -2291 <br />Spouse's Social Security Number <br />Dale of Lien <br />August 30, 2021 <br />lien Type: <br />County <br />HALL <br />Li Original ■ Continuation <br />• Corrected <br />MSS <br />Taxpayer Name and Mailing Address <br />MELISSA DE LEON <br />1903 W DIVISION <br />GRAND ISLAND NE 68803 <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 />11/03/2020 <br />$618.07 <br />$31.30 <br />$26.91 <br />676.28 <br />Total <br />$676.28 <br />sign <br />here <br />I certify that the Nebraska Department of Revenue has 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 after demand. This Notice of State Tax Lien is an effective lien and serves to continue the priorly of <br />the State's Merest in the affected property of the taxpayer. <br />Preparer's Signature . <br />thorixed Sgnatt re <br />Revenue Agent 08/30/2021 (402)471-0987 <br />Title Date Phone Number <br />Revenue Supervisor 08/30/2021 <br />Title Data <br />4.4944974 044 6201e Supersedes 4-940-1974 Ran. 8-2013 <br />