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Good 1,1e. Great Service, ..w..r.ww. 4• nvs.ur NE Sec of State - Robert B. Evnen Filing Document #: 2205000543-7 Pages: 1 Debtor Name: FERNANDO B CRUZ Filing Date and Time: 05/11/2022 10:30 AM Notice of State Tax Lien This Notice of State Tax Lien Is issued by the Nebraska Department of Revenue for unpaid taxes administered by the Tax Commissioner. Taxes, including penalties, interest, and costs, which are shown below, ere due from the taxpayer and remain unpaid after demand.These taxes are a lien for all property located in the county and rights to property owned by the taxpayer or acquired before the expiration of this lien.This Tien win expire and become unenforceable 10 years after the date of recording 11 no continuation statement Is recorded on or prior to the expiration of the previous lien or continuation statement. PLEASE 00 NOT WRITE N THIS SPACE NedeskI ID Number 97578061 Federal ID Number NO FEIN Lien Serial Number 12298705 Uen Fled Nlih: Social Seourtty Number XXX-XX.0058 Spousea Social Security Number NO SPOUSE SSN i;1 r+eg+cnr or Deeds • County Clerk Dale of Llan May 5, 2022 Lien Thar Elconsctec cowry HALL E1 Odgpnal ❑conarwuwo usiness Name and Location Address Taxpayer Name and Malting Addy*, FERNANDO B CRUZ 417 EAST 511-1 GRAND ISLAND NE 68801 Tax Program Tax Period Date of Assessment Tax Penalty Interest Costs Total Due Individual 2018 05/30/2021 $480.00 $24.00 $60.49 $564.49 Total $584.49 sign here 1 certify that the Nebraska Department of Revenue has complied alh the laws of bre Stats of Nebraska in detemrining 11e amount shown m be due. and that the taxpayer has tailed m pay the amour due atter demand. This Notice of Siete Tax Lien is an etlesliw len and serves to c0nbnu0 914 priority of the State's interest in the affected properly of the taxpayer. Revenue Agent Tale 05/05/2022 (308)632-1206 Data Phone Number Revenue Supervisor 05/05/2022 Tile Dam 4494.1974 Hex 02018 5u5155205 4.949.1974 AWL 64013