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_N. 5+4 <br />coxsxd Lee. Great Serve, <br />NE Sec of State - Robert B. Evnen <br />Filing Document #: 2204000435-0 Pages: 1 <br />Debtor Name: FRANCO GONZALEZ CUELLAR <br />Filing Date and Time 04/08/2022 08:57 AM <br />Notice of State Tax Lien <br />202202561 <br />This Notice of Stale 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 />PLEASE DO NOT WRITE INTHIS SPACE <br />Nebraska ID Number <br />48096474 <br />Federal ID Number <br />NO FEIN <br />Lien Serial Number <br />12295886 <br />Lien Filed With: <br />Social Security Number <br />XXX -XX -0656 <br />Spouse'S Social Security Number <br />NO SPOUSE SSN'. <br />/4 'swat Deeds ❑ County Clerk <br />Date of Lien <br />April 4, 2022 <br />Lion Type: <br />® Original ❑ Continuation ation ❑ Corrected <br />County <br />HALL <br />Business Name and Location Address <br />Taxpayer Name and Mailing Address <br />FRANCO GONZALEZ CUELLAR <br />1711 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 />2018 <br />08/02/2019 <br />$235.00 <br />$62.75 <br />$89.79 <br />$387.54 <br />Individual <br />2020 <br />06/11/2021 <br />$396.00 <br />$19.80 <br />$10.48 <br />$426.28 <br />Total <br />$813.82 <br />I certify that the Nebraska Department of Revenue has complied with the laws of the State of Nebraska in determining the amount shown to be due. <br />and that the taxpayer has failed to pay the amount due after demand. This Notice of State Tax Lien is en effective lien and serves to continue the priority of <br />the State's Interest In the affected property of the taxpayer. <br />sign <br />here rw <br />sparer s Signature <br />hori2ed Sign re <br />Revenue Agent 04/04/2022 (402)471-6043 <br />Title Date Phone Number <br />Revenue Supervisor 04/04/2022 <br />Title Date <br />4.4s4.1974 Pee tl•2o1$ Supersedes 4-949-1974 rev. 6-2013 <br />