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o -e <br />I <br />Goad Life. great Servcw. <br />20 <br />..8544 <br />NE Sec of State - Robert B. Evnen <br />Filing Document #: 2110000259-4 Pages: 1 <br />Debtor Name: THOMAS 0 EASTWOOD <br />Filing Date and Time: 10/07/2021 10:33 AM <br />Notice of State Tax Lien <br />This Notice of State Tax Uen 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 />43057780 <br />Federal ID Number <br />Lien Serial Number <br />12181900 <br />Len Filed With: <br />Social Security Number <br />XXX -XX -7359 <br />Spouse's Social Security Number <br />® Register of Deeds ■ County perk <br />Date of Len <br />September 30, 2021 <br />Len Type: <br />❑corrected <br />County <br />HALL <br />l3 original ❑Continuation <br />Business Name and Location Address <br />Taxpayer Name and Mailing Address <br />THOMAS 0 EASTWOOD <br />2220 W 13TH STREET <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 />2014 <br />04/16/2021 <br />$4,439.00 <br />$1,284.25 <br />$1,197.38 <br />6,920.63 <br />Individual <br />2015 <br />04/16/2021 <br />$5,846.00 <br />$1,564.41 <br />$1,192.26 <br />8,602.67 <br />Individual <br />2016 <br />04/16/2021 <br />56,464.00 <br />$1,732.07 <br />$1,124.39 <br />9.320.46 <br />Total <br />$24,843.76 <br />I certify that the Nebraska Department of Revenue has complied with the taws of the State of Nebraska at determining the amount shown to be due. <br />end that the taxpayer has tailed to pay the amount due after demand. This Notice of State Tax Lien a an effective lien and serves to continue the priority of <br />the State's interest In the aSectad property of the taxpayer. <br />sign, <br />Preparers Signature <br />%{".lam <br />9i thoriZed Signatre <br />Revenue Agent 09/30/2021 (402)471-5928 <br />Title Date Phone Number <br />Revenue Supervisor 09/30/2021 <br />Title Date <br />4-494.197a RM. 8-2018 Serenade. 4-9o9•197s Rev. 6.2013 <br />