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NEBRASKA, Good Lire. Greet Service. 202110639 NE Sec of State - Robert B. Evnen Filing Document #: 2112000944-3 Pages: 1 Debtor Name: STEPHANIE ORTIZ Filing Date and Time: 12/16/2021 11:34 AM Notice of State Tax Lien This Notice of Stats Tax Lien Is issued by the Nebraska Department of Revenue for unpaid taxes administered by the Tax Commissioner. Taxes, including penalties, interest, end costs, which are shown below, are due from the taxpayer and remain unpaid after demard.These taxes are a lien for all property located in the county and rights to property owned by the taxpayer or acquired before the expiration of this lien. This lien will expire and become unenforceable 10 years after the date of recording if no continuation statement is recorded on or prior to the expiration of the previous lien or continuation statement. PLEASE DO NOT WRITE INTENS SPACE Nebraska ID Number 98725476 Federal 10 Number Lien Serial Number 12186991 Lien Fled Vieth: Social Security Number XXX -XX -5584 Spouse's Social Security Pknfier F7 Register of Deeds ■ county Clerk Date of Llan December 08, 2021 Lien Type: ❑Conscted County HALL ®orgwu ■ Continuation Business Name and Location Address Taxpayer Name and Mailing Address STEPHANIE ORTIZ 424 COMMANCHE AVE GRAND ISLAND NE 68803 Tax Program Tax Period Date of Assessment Tax Penalty Interest Costs Total Due Individual 2018 05/15/2020 $258.00 $64.50 $29.38 351.88 Total $351.88 I certify that the Nebraska Department of Revenue has complied with the laws of the Siete of Nebraska in dNerminwg the amount shown to be due, and that the taxpayer has Wed b pay the amount due after demand. This Nodes of State Tax Lien Is en elective len and serves b continue the priority of the State% lousiest in the affected property of the la/payer. sig n ek 8ttM#-ather - Authori ed signature Revenue Anent 12/08/2021 (308)632-1210 Tree Date Phone Number Revenue Supervisor 12/08/2021 Tile Date 41-4a4-1574 Pew 82018 %pomades 4440 074 flew 82013