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o`b <br />NJEBRA-614A- <br />Good Lire. Great Seetirce. <br />torour.wo Of RPV.016 <br />NE Sec of State - Robert B. Evnen <br />Filing Document #: 2203000607-6 Pages: 1 <br />Debtor Name: MICHAEL POTTER <br />Filing Date and Time: 03/10/2022 09:36 AM <br />Notice of State Tax Lien <br />202201.744 <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 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 />PLEASEDONOTWRITEINTHISSPACE <br />Nebeaste 10 Number <br />98001807 <br />lederaI ID Nambar <br />NO FEIN <br />Lien Serial Number <br />12293369 <br />Lana Flied Wine <br />53 Heigssfer of Deeds Occunty Clerk <br />Social Security Number <br />X -XX -8708 <br />Spuses SOdet Secutity Nemtter <br />NO SPOUSE SSN <br />Mite of Lien <br />March 7. 2022 <br />L <br />0 Corrected <br />County <br />HALL <br />,4 Original 0 Continuation <br />Business Name and Location Address <br />Taxpayer Name and Mailing Address <br />MICHAEL POTTER <br />2413 W CHARLES ST <br />GRAND ISLAND NE 66801 <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 />08/18/2020 <br />$1,386.00 <br />$346.50 <br />$16795 <br />$1,900.45 <br />Individual <br />2020 <br />11/05/2021 <br />$3,040,00 <br />$219.28 <br />$7346 <br />$3,33274 <br />Total <br />$5,233.19 <br />1 coney that the Nebraska Department of Revenue has complied with the laws of the Stele of Nebraska In determining the amount shown to be due, <br />and that the taxpayer has failed to pay the amount due alter demand. This Notice of State Tax Lien Is en effective ken and serves to continue the priority of <br />the State's interest in the affected property of the taxpayer. <br />sign <br />here Preparers Signet <br />Revenue Agent 03/07/2022 (402)471-5928 <br />Title Date Phone Number <br />Revenue Supervisor 03/07/2022 <br />Title Date <br />44944974 Re.. 841318 Superseder 4449.1974 Read -2013 <br />