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NEB&RA5i cA- <br />Gocd Lire. Great Se,,cv. <br />202110067 <br />NE Sec of State - Robert B. Evnen <br />Filing Document #: 2111001414-5 Pages: 1 <br />Debtor Name: ALEXANDER T PEREZ <br />Filing Date and Time: 11/29/2021 09:49 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 Tien 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 Ilen or continuation statement. <br />PLEASE 00 NOT WRITE IN TFa$ SPACE <br />Nebraska ID Number <br />45892695 <br />Federal lD Number <br />Lien Serial Number <br />12185611 <br />Lien Filed With: <br />Social Security Number <br />XXX.XX-3405 <br />Spouse's Saolei Security Number <br />i7 Register of Deeds O County perk <br />Date of Lien <br />November 17, 2021 <br />Lien Type: <br />0Comscted <br />County <br />HALL <br />LI onpinat ■ Conawauon <br />and location <br />Taxpayer Name and Mailing Address <br />ALEXANDER T PEREZ <br />407 W CHARLES ST <br />GRAND ISLAND NE 68801 <br />Tax Program <br />Tax Pe nod <br />Date of <br />Assessment <br />Tax <br />Penalty <br />Interest <br />Costs <br />Total Due <br />Individual <br />2019 <br />06/11/2021 <br />$1,312.00 <br />$328.00 <br />$64.99 <br />1,704.99 <br />Individual <br />2020 <br />06/11/2021 <br />$4,517.00 <br />$307.85 <br />$68.31 <br />4,893.18 <br />Total <br />$6,598.15 <br />I certify that the Nebraska Department of Revenue has complied with the laws of the State 01 Nebraska in determiritg Me amount shown to be due. <br />and that the taxpayer has tailed b pay the amount due after demand. This Notice of State Tax Lien is an elective Nen and serves to continue he priority 01 <br />the Slate's interest in the aRected property 01 the /$Myec <br />sign gua t "/„A <br />here �� 4%6& <br />Authorized Signature <br />Revenue Agent 11/17/2021 (308)632-1210 <br />Title Dale Phone Number <br />Revenue Supervisor 11/17/2021 <br />Title De. <br />4.4101-1974 Rer. 62016 Summate 4-949.1974 iW. 9.2013 <br />