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Good Life. Great Service. <br />DIMITICATOIMMIN <br />NE Sec of State - Robert B. Evnen <br />Filing Document #: 2205000709-1 Pages: 1 <br />Debtor Name: CHASE A SMITH <br />Filing Date and Time: 05/17/2022 10:08 AM <br />Notice of State Tax Lien <br />202203613 <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 Iien.This lien wig --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 Tin SPACE <br />Nebraska ID Number <br />903$3331 <br />Federal <br />NO FEIN <br />0 N <br />Leen Serial Number <br />12299288 <br />Lien Riad UM <br />Sadal Security Number <br />XXX -XX -5466 <br />Sptaarda Social Security Number ' <br />NO SPOUSE SSN <br />l l Reglater of Deeds ['County Clark <br />Date of Lien <br />May 12, 2022 <br />Lien Tye <br />gj (mond 0commotion ©coetected <br />County <br />HALL <br />uslftese Name end Location Address <br />Taxpayer Name and Mailing Address <br />CHASE A SMITH <br />321 E 6TH <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 />11/0512021 <br />$514.00 <br />$53.78 <br />$26.14 <br />$593,92 <br />Total <br />$593.92 <br />I certify fiat the Nebraska Department of Revenue has complied with the laws of the State 01 Nebraska to determining the amount shown to be duet', <br />and that the taxpayer has failed to pay the amouM due after demand.Thda Notice of State Tax Liver bran emotive lief and nerves to continue the priority of <br />the Stales interest In the affected property of the lenpayer. <br />sign k Tsllate Abhu." Revenue Anent 05/12/2022 (308)632-1206 <br />here r Prepare'. spit. Tits pate Phone Number <br />J441, ,r44 & Revenue Supervisor 05/12/2022 <br />Authorized Signature Tete Date <br />4.494.1974 nee 92018 tiversedee 4.9994978 Hee 54013 <br />