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NASi4 <br />(iced Lk, Great Service. <br />eimovm.or vMW <br />NE Sec of State - Robert B. Evnen <br />Filing Document #: 2204000808-2 Pages: 1 <br />Debtor Name: ADAM L MARINE <br />Filing Date and Time: 04/15/2022 09:39 AM <br />Notice of State Tax Lien <br />202202800 <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 170 NOT WRITE IN THIS SPACE <br />Nebeask.a ID Number <br />35680261 <br />Fedemt ID Number <br />NO FEIN <br />Lien Serial Number <br />12296337 <br />Lien Fled With: <br />® Register of Deeds ā¯‘County Clerk <br />Social Security Number <br />XXX -XX -1$58 <br />Spouse's Social Security Number <br />NO SPOUSE SSN <br />Date of lien <br />April 7, 2022 <br />Lien Type: <br />[]Corrected <br />County <br />HALL <br />VA Original E] Continuation <br />Business Name and Location Address <br />Taxpayer Name and Mailing Address <br />ADAM L MARINE <br />1013 N GREENWICH STREET <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 />2018 <br />06/16/2021 <br />$430.00 <br />$107.50 <br />$53.20 <br />$590.701 <br />Total <br />$590.701 <br />t certify that the Nebraska Department of Revenue has complied with the lawsof lite Slate of Nebraska in determining the amount shown to be due, <br />arid Oral the taxpayer has failed to pay the amount due alter demand. This Notice of Stale Tax Lien is an effective hen and serves to continue the priority of <br />the State's interest in the affected property of the taxpayer. <br />sign, <br />here Prep 's Signature <br />Aut <br />stare > <br />Revenue Agent <br />Tile <br />Revenue Supervisor <br />04/07/2022 (308)632-1206 <br />Date Phone Number <br />04/07/2022 <br />Title <br />Date <br />4.4941074 Rey 8201e Supersedes 4.949.1934 Rev. e -2o13 <br />