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Nom._QR KA <br />.- <br />Goad 1 ire. Great Service. <br />esamua, e. trivittnoe <br />NE Sec of State - Robert B. Evnen <br />Filing Document #: 2204000806-4 Pages: 1 <br />Debtor Name: PAUL ANTILLON <br />Filing Date and Time: 04/15/2022 09:36 AM <br />Notice of State Tax Lien <br />22262;99 <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 />PLEASE 00 NOT WRITE IN THIS SPACE <br />Nebraska 0) Number <br />99128047 <br />Federal ID Number <br />NO FEIN <br />Lien Serial Number <br />12296271 <br />Lien Filed Wfith: <br />® Registeret'Deeds 0County cladt <br />Social Security Number <br />XXX -XX -7859 <br />Spouse's Social Sec Number <br />NO SPOUSE SSN <br />Date of Lien <br />April 7, 2022 <br />Lien Type: <br />© Corrected <br />County <br />HALL <br />►1 Original Q Continuation <br />siness Name and Location Address <br />Taxpayer Name and Mailing Address <br />PAUL ANTILLON <br />1522 W NORTH FRONT ST <br />GRAND ISLAND NE 68801 <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 />2020 <br />12/10/2021 <br />$756.00 <br />551.43 <br />$20.19 <br />$827.62 <br />Total <br />$827,62 <br />I certify that the Nebraska Department of Revenue has complied with the laws of the State al Nebraska in determining the amount shown to be due., <br />and that the taxpayer has tailed to pay the amount due atter demand. This Notice of State Tax Lien is an effective lien and serves: to continue the priority of <br />the State's interest in the elected properly of the taxpayer. <br />sign` 5' ; <br />here I Prepera'' - Sigratur <br />thor/d :lr(Tture <br />Revenue Agent <br />Title <br />Revenue Supervisor <br />04/07/2022 (308)632-1205 <br />Date <br />Phone Number <br />04/07/2022 <br />Tine Date <br />4-494`974 Rett 0.2010 Supersedes 4-949-1974 rex 0.2013 <br />