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Good Life. Great Se'•nce. <br />NE Sec of State - Robert B. Evnen <br />Filing Document #: 2112000225-5 Pages: 1 <br />Debtor Name: PAUL ANTILLON 1•°" <br />Filing Date and Time: 12/03/2021 09:16 AM <br />Notice of State Tax Lien <br />202110271 <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 Iien.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 />99128047 <br />Federal ID Number <br />Lien Serial Number <br />12186093 <br />Lien riled With: <br />1E Register of Deeds 0 County Clete <br />Social Security Number <br />XXX -XX -7859 <br />Spouses Social Security Number <br />Date of Lien <br />November 24, 2021 <br />Lien Type: <br />®Original Demoatop 0Corrected <br />County <br />HALL <br />ress <br />Taxpayer Name and Mailing Address <br />PAUL ANTILLON <br />1522 W NORTH FRONT ST <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 />Individual <br />2018 <br />11/03/2020 <br />$411.00 <br />$102.75 <br />$46.32 <br />560.07 <br />Individual <br />2019 <br />11/03/2020 <br />$652.00 <br />$46.32 <br />$32.67 <br />730.99 <br />Total <br />$1,291.06 <br />sign <br />here <br />I certify that the Nebraska Department of Revenue has complied with the laws of the State of Nebraska in determining the amount shown St bo due. <br />end that the taxpayer has tailed to pay the amount doe after demand. This Notice 01 State Tax Lien is an effective Pen and serves to continue the priority of <br />the Stales interest in the affected property of the taxpayer. <br />Preps rs Signatur <br />e <br />T <br />lure <br />Revenue Agent 11/24/2021 (308)632-1208 <br />Title Dale Phone Number <br />Revenue Supervisor 11/24/2021 <br />Tae Date <br />4-4114-1974 net 64018 Supersedes 4.eu9-1974 Hee a-2013 <br />