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L.fe Grea7 <br />NE Sec of State - Robert B. Evnen <br />Filing Document #: 2110000499-0 Pages: 1 <br />Debtor Name: PATRICK A HORTON <br />Filing Date and Time: 10/14/2021 11:25 AM <br />Notice of State Tax Lien <br />;102108 732 <br />This-, Notic4 c; State Tax Lien is issued by the Nebraska <br />Department ..f kevenue for unpaid taxes administered by the Tax <br />Commissioner. Taxes, including penalties, interest, and costs, <br />which are shown below, are due from the +,xpayar -• d rernain <br />unpaid atter demand. These taxes area lien fv all prop. y located <br />in the county and rights to property owned by the taxpayer or <br />acquired before the expiration of this Iien.This lien will expire and <br />become unenforceable 10 years after the date of recording 11 no <br />continuation statement is recorded on or prior to the expiration of <br />the previous lien or continuation statement. <br />(;'LEASE DO NOT ',MITE It i ;? SPACE <br />Nebraska 10 Number <br />94089264 <br />Federal 0 Number <br />Lien Serial Number ( Lien Filed With: <br />® Register c/ Deeds County Clerk <br />12182162 <br />Date of Lien <br />October 06, 2021 <br />Social Security Number <br />XXX -XX -6763 <br />Spouses Social Security Number <br />Lien Type: <br />Original <br />Continuation © Correcleo <br />County <br />HALL <br />Business Name and Location Address <br />Taxpa er Name and Mailing Address <br />PATRICK A HORTON <br />4870 HWY 30 APT 4 <br />ALDA NE 68810 <br />Tax Program <br />Tax Period <br />Date of <br />Assessment <br />Tax <br />' Penalty <br />1 Interest <br />Costs <br />Total Due <br />Individual <br />2020 <br />f <br />06/11/2021 <br />$423.00 <br />$41.15 <br />$4.94 <br />469.09 <br />Total <br />$469.09 <br />I certify that the Nebraska Department of Revenue has complied with the laws of the State of Nebraska In determining the amount shown to be due, <br />and that the taxpayer has tailed to pay the amount due after de rrand.This Notice of State Tax Lan is an elsective lien and serves to cont -nue the priority of <br />the Stales interest in the affected properly of 00 taxpayer. <br />here eY 4`/Le 2 vt. ! <br />ein toy /C. <br />Authorizedated ignuro <br />Revenue Agent 10/06/2021 (308)632-1206 <br />Titlo Date Phone Number <br />Revenue Supervisor 10/06/2021 <br />Title Date <br />4.494-1974 Rev. 52018 Supersedes 4-949.1974 Rev 8.2013 <br />