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NEBR. <br />AG -1476k - <br />Coco Lite Crew, Servtere. <br />NE Sec of State - Robert B. Evnen <br />Filing Document 19: 2111000152-1 Pages: 1 <br />Debtor Name: KAILEY B FRITZ <br />Filing Date and Time 11/02/2021 12:03 PM <br />Notice of State Tax Lien <br />202109297 <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 00 NOT WRITE IN THIS SPACE <br />Nebraska 10 Number <br />93228732 <br />Federal D Number <br />Lien Serial Number <br />12183350 <br />Lien Filed With: <br />® Register or Deeds 0 County Clerk <br />Social Security Number <br />XXX -XX -8064 <br />Spouse's Social Security Number <br />Dare of Lien <br />October 22, 2021 <br />Lien Type: <br />®Original 0Continuation [Corrected <br />Courtly <br />HALL <br />Business Name and Location Address <br />Taxpayer Name and Mailing Address <br />KAILEY B FRITZ <br />904 RIDGEWOOD AVE <br />GRAND ISLAND NE 68803 <br />Tax Program <br />1 <br />Tax Period <br />Date of <br />Assessment <br />( <br />Tax <br />Penalty <br />Interest <br />Costs <br />Total Due <br />Individual <br />2020 <br />06/11/2021 <br />j <br />$52,410.00 <br />$2,640,50 <br />$680.61 <br />55,731.11 <br />Total <br />$55,731.11 <br />I certify that the Nebraska Department of Revenue has complied with me 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 demand. This Notice of State Tax Lien is an effective ken and serves to continue the priority of <br />Me Slate's interest in the affected property of the taxpayer, <br />sign <br />here PrepauSSgnatine ;, <br />".��� <br />Revenue Agent 10/22/2021 (402)471-5712 <br />Title Date Phone Number <br />Revenue Supervisor 10/22/2021 <br />authorized Signature ) Title Date <br />4.494-1974 Rea. 8.1019 Sv earl, 4-ede-te74 Per &2013 <br />