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Goad Life. Civet service. <br />cT..4�wr.rt <br />NE Sec of State - Robert B. Evnen <br />Filing Document #: 2204000812-5 Pages: 1 <br />Debtor Name: JACKIE MAGLIONE <br />Filing Date and Time: 04/15/2022 09:43 AM <br />Notice of State Tax Lien <br />2022ti2S0i <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 DO NOT WRITE IN THIS SPACE <br />Nebraska ID Number <br />93419317 <br />Federal ID Number <br />NO FEIN <br />Lien Serial Number <br />12296018 <br />Lien tied With; <br />Register of Deeds ID County clerk <br />Social Security Number <br />XXX -XX -0038 <br />Spouse's Social Secretly Number <br />NO SPOUSE SSN <br />Date of Lien _ <br />April 5, 2022 <br />t _ <br />Lien Type: <br />®original 0corninralion Dcorrectad <br />County <br />HALL <br />ustness Name and Location Address <br />Taxpayer Name and Mailing Address <br />JACKIE MAGLIONE <br />504 N DARR <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 />2017 <br />05/28/2021 <br />$805.00 <br />$40.25 <br />$128.25 <br />5973.50 <br />Total <br />$973.50 <br />I certify that the Nebraska Department of Revenue has complied with the laws of the Stale of Nebraskain determining the amount shown to be duo, <br />and that the taxpayer has failed to pay the amount due after demand. This Notice of Stale Tax Lien is an effective lien and serves to continuo the priority of <br />the Stales Interest in ale affected properly of the taxpayer. <br />Sign Sa4ez, <br />here Proparer'slure <br />Authorize <br />Revenue Agent 04/05/2022 (308)632-1208 <br />Title Date Phone Number <br />Revenue Supervisor 04/05/2022 <br />Title Deco <br />4-444-1974 Rev. 8.2018 S. -peewees 4949-te74 Roe. 9-2013 <br />