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NJEE.BPrOkEli414t- <br />Good Life. Great Serdce. <br />610.1111•4104 Of INPIP.M11 <br />NE Sec of State - Robert B. Evnen <br />Filing Document #: 2112001101-3 <br />Debtor Name: CARLOS I CABELLO ROJAS <br />Filing Date and Time: 12/21/2021 10:04 AM <br />Pages: 1 <br />Notice of State Tax Lien <br />202110799 <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 tien.This lion 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 INTMS SPACE <br />Nebraska 10 Netter <br />40401146 <br />Federal ID Number <br />Lien Serial Number <br />12187477 <br />Lien Feed with: <br />Social Security Number <br />XXX -XX -1139 <br />Spouse's Social Security Number <br />i7 Register of Deeds • Coumy Clens <br />Date of Lion <br />December 16, 2021 <br />t ien Type: <br />El corrected <br />County <br />HALL <br />!A oris tat ❑Coranuation <br />ness Name and Location Address <br />Taxpayer Name and Mailing Address <br />CARLOS I CABELLO ROJAS <br />2331 N PARK AVE <br />GRAND ISLAND NE 68803 <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 />2016 <br />10/02/2020 <br />$157.00 <br />$39.25 <br />$28.30 <br />224.55 <br />Total <br />$224.55 <br />I certify that the Nebraska Department of Revenue has complied with the laws of the Stale of Nebraska in determining the amount shown to be due. <br />and that the taxpayer has faded to pay the amount due after demand. This Notice of State Tax Lien is an effective lien and serves to continue the priority of <br />the State's interest in ate affected property of the taxpayer, <br />sign��- 7 <br />here r Preparers Signature <br />1 -0 -,01/24416 -- <br />Authorized Signature <br />Revenue Agent <br />Title <br />Revenue Supervisor <br />12/16/2021 (308)632-1208 <br />Date Phone Number <br />12/16/2021 <br />Title Date <br />4494.1974 flee. ante Sueersoaes 4849.1974 Weis t-2013 <br />