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Good Lie. Great Service, <br />xrx,measm4iviw46 <br />NE Sec of State - Robert B. Evnen <br />Filing Document #: 2205000939-0 Pages: 1 <br />Debtor Name: ISEL SARMIENTO ROSA <br />Filing Date and Time: 05/20/2022 10:11 AM <br />Notice of State Tax Lien <br />20220375z <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 area 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 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 />9332826$ <br />Federal <br />NO FEIN <br />0 Number <br />Lien Serial Number <br />12299322 <br />Lien filed WON: <br />Social Security Number <br />XXX -XX -7807 <br />Spouses Social Security Number <br />NO SPOUSE SSN <br />® Register of Deady ■ County Cleru <br />Date of Llen <br />May 13, 2022 <br />Uen Type: <br />❑Corrected <br />County <br />HALL <br />1;1 original ❑continuation <br />Business Name and Location Address <br />Taxpayer Name and Mailing Address <br />ISEL SARMIENTO ROSA <br />104 W 11TH 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 />11/29/2021 <br />$1,206.73 <br />$67.05 <br />$154,57 <br />$1,428.35 <br />Individual <br />2019 <br />11/29/2021 <br />$1,506.00 <br />$75.30 <br />$96.51 <br />$1,677.81 <br />Total <br />$3,106.16 <br />I oertey that the Nebraska Department of Revenue has contorted with the laws of the State of Nebraska in determining the amount shown to be due. <br />and that the taxpayer has tailed to pay the amount due after demand. This Notice of Stale Tax Lien is an effective ken and serves to continue the priority of <br />the Stands interest in Ole affected property of the taxpayer. <br />sign ,, LaI <br />e <br />here 'v,Preparers Signature <br />Lf ,tJeSet <br />Authorised Signature <br />Revenue Ascent <br />Title <br />Revenue Supervisor <br />05/13/2022 (308)632-1201 <br />Date Phone Number <br />05/13/2022 <br />Ttie Date <br />4494-1974 Flex 8-2018 Supersedes 4449.1074 Rev 8.2013 <br />