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202108731
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Last modified
10/14/2021 3:44:20 PM
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10/14/2021 3:44:20 PM
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DEEDS
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202108731
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NESS A <br />Froori Lie Gres Serv.ce. <br />IKVVOWIt <br />NE Sec of State - Roben B. Evnen <br />Filing Document #: 2110000487-5 <br />Debtor Name JASON LAWHORNE <br />Filing Date and Time: 10/14/2021 10:30 AM <br />Pages: 1 <br />Notice of State Tax Lien <br />:02108731 <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 />12615285 <br />Federal ID Number <br />Lien Serial Number <br />12104632 <br />Lien Fed with: <br />Social Security Number <br />LXX -XX -0229 <br />Spouse's Social Security Number <br />E9 Register 0l Deeds • County Clerk <br />Date of Lien <br />October 5, 2021 <br />Lien Type' <br />rm Original DContinuation 0Coeeected <br />County <br />HALL <br />Business Name and Location Address <br />Taxpayer Name and Mailing Address <br />JASON LAWHORNE <br />339 S OAK STREET <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 />08/01/2019 - 07/31/2020 <br />04/27/2021 <br />500.00 <br />100.00 <br />20.48 <br />.00 <br />620.48 <br />Total <br />620.48 <br />sign <br />here <br />t certify that the Nebraska Department of Revenue has complied with the laws of the State of Nebraska In determining the amount shown b be due, <br />and that the taxpayer/has failed to pay the amount due after demand. This Notice of Stale Tax Lien to an effective hen and serves to continue Itle priority of <br />Me S le's interest in ta fleeted property of the taxpayer. <br />I j/eV,. % �l /A J J ) <br />i. Revenue Agent 10/05/2021 402-471-5956 <br />Pr eyd jf ' tore e Date Phone Number <br />L.. sem/ Revenue Senior Agent 10/05/2021 <br />Authorized Sig e . Title Date <br />4.434.197a Rio (•2019 Supersedes 4-949.1974 Rem 6.2013 <br />
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