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Good Lite. Great Samos. <br />ORMAT.411, SM reiram t <br />NE Sec of State - Robert B. Evnen <br />Filing Document #: 2204001371-0 <br />Debtor Name: LIL1ANA A OXLAJ JUAREZ <br />Filing Date and Time: 04/27/2022 10:26 AM <br />Pages: 1 <br />Notice of State Tax Lien <br />202203105 <br />This Notice of State Tax <br />Department of Revenue for <br />Commissioner. Taxes, including <br />which are shown below, <br />unpaid after demand. These <br />in the county and rights <br />acquired before the expiration <br />Lien Is Issued by the Nebraska <br />unpaid taxes administered by the Tax <br />penalties, interest, and costs, <br />are due from the taxpayer and remain <br />taxes are a lien for all property located <br />to property owned by the taxpayer or <br />of this lien.This lien will expire and <br />years after the date of recording If no <br />recorded on or prior to the expiration of <br />statement. <br />PLEASE 00 NOT WRITE IN THIS SPACE <br />become unenforceable 10 <br />continuation statement is <br />the previous lien or continuation <br />Nebrastra. ID Number <br />12674982 <br />Federal ID Number <br />813977285 <br />Lien Serial Number <br />12208502 <br />Lien Flier] With: <br />Social Security Number <br />XXX -XX -0570 <br />Spouse's Social Securby Number <br />NO SPOUSE SSN <br />(] Register of Deeds ■ County Clark <br />Dale of Lien <br />April 18, 2022 <br />Lien Type: <br />[JCorreck+d <br />County <br />HALL <br />® Orykhai • Continestion <br />Business Name and Location Address <br />Taxpayer Name and Mailing Address <br />LILIANA A OXLAJ JUAREZ <br />510 WHITE AVE <br />GRAND ISLAND NE 68803-4655 <br />Tax Program <br />Tax Period <br />Date of <br />Assessment <br />Tax <br />Penalty <br />Interest <br />Costs <br />Total Due <br />Litter Fee <br />07/01/2018 - 06/30/2019 <br />11/08/2020 <br />50.00 <br />30.00 <br />5.09 <br />.00 <br />85.09 <br />Sales <br />07/01/2019 - 09/30/2019 <br />11/08/2020 <br />3,750.00 <br />750.00 <br />370.77 <br />.00 <br />4,870.77 <br />Sales <br />10/01/2019 - 12/31/2019 <br />11/08/2020 <br />3,750.00 <br />650.00 <br />323.51 <br />100.00 <br />4,823.51 <br />Sales <br />01/01/2020 - 01/31/2020 <br />11/08/2020 <br />1,250.00 <br />250.00 <br />102.49 <br />.00 <br />1,602.49 <br />Sales <br />02/31/2020-02/292020 <br />11108/2020 <br />1,250.00 <br />250.00 <br />97.53 <br />.00 <br />1,597.53 <br />Sales <br />03/01/2020 - 03/31/2020 <br />11/08/2020 <br />1,250.00 <br />250.00 <br />92.22 <br />.00 <br />1,592.22 <br />Sales <br />04/01/2020 - 04/30/2020 <br />11/08/2020 <br />1,250.00 <br />250.00 <br />87.08 <br />.00 <br />1,587.08 <br />Sales <br />05/01/2020 - 05/31/2020 <br />11/08/2020 <br />1,250.00 <br />250.00 <br />81.78 <br />.00 <br />1,581.78 <br />Sales <br />06/01/2020-06/30/2020 <br />11/08/2020 <br />1,250.00 <br />250.00 <br />76.64 <br />.00 <br />1,576.64 <br />Sales <br />07/01/2020 - 07/31/2020 <br />01/04/2021 <br />1,250.00 <br />150.00 <br />71.33 <br />100.00 <br />1,571.33 <br />Total <br />20,888.44 <br />sign <br />here <br />I certify that the Nebraska Department of Revenue has compiled with the laws of the State of Nebraska in determining the amount shown to be die, <br />and that theta .. r has tailed to pay the amount our demand. This Notice of State Tax Lien is en effective lien and serves to continue the priority of <br />the States , - n the affected properly Of the tuba <br />radii IriV- t r. <br />Autho <br />ed Signature <br />Revenue Agent <br />Tale <br />Revenue Supervisor <br />04/11/2022 402-471-5711 <br />Date <br />Title <br />Phone Number <br />4/11/2022 <br />Date <br />44944974 Rev. S-tOt3 Supersedes 444019744 Ren. &2013 <br />