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NEBRASKA - <br />Goad <br />n_A <br />Good Lde. Great Serv;ce. <br />.n..rrw..w..+..w <br />NE Sec of State - Robert B. Evnen <br />Filing Document #: 2112001037-9 Pages: I <br />Debtor Name: RACHAEL MEHAFFIE <br />Filing Date and Time: 12/20/2021 11:08 AM <br />Notice of State Tax Lien <br />202110747 <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 Nen. This lien will expire and <br />become unenforceable 10 years after the data 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 />94751625 <br />Federal ID Number <br />Lien Serial Number <br />12187439 <br />Lien Filed With: <br />®rear of Deeds O county Gent <br />Social Securky Number <br />XXX -XX -7193 <br />Spouse's Social Security Number <br />XXX -XX -4898 <br />Dale of Lien <br />December 14, 2021 <br />Lien Type: <br />❑Gweected <br />County <br />HALL <br />-I Original ❑Continuation <br />n AtlOreas <br />Taxpayer Name and Malting Address <br />RACHAEL MEHAFFIE <br />DANIEL MEHAFFIE <br />11 BUTTERFLY IN <br />HEDGESVILLE WV 25427 <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 />2017 <br />11/08/2019 <br />$371.00 <br />$37.00 <br />$83.04 <br />491.04 <br />Total <br />$491.04 <br />I certify that the Nebraska Department of Revenue has complied with the lam of the Stale of Nebraska In determining the amount shown to be due, <br />and that Me taxpayer has failed to pay the amount due after demand. This Notice 01 State Tex Lien is an efieottve ken and serves to continue the priority of <br />the Satds Interest in the elected properly of the taxpayer. <br />sign 1 a►-u7ye4-nc <br />here Predator's Signature <br />Lzezi 4%64 <br />Authorized Signature <br />Revenue Agent <br />Tale <br />Revenue Supervisor <br />12/14/2021 (402)471-5833 <br />Date Phone Number <br />12/14/2021 <br />1111e Date <br />4-494.1974 Nov. 82016 809er4e4144 4049.1974 ROY. 14013 <br />