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A- <br />GooO Life. Great Semce, <br />I M T440 eV0MMVr <br />NE Sec of State - Robert B. Evnen <br />Filing Document #: 2205000954-9 Pages: 1 <br />Debtor Name: DIXANDER GUERRA MARTINEZ <br />Filing Date and Time: 05/20/2022 10:39 AM <br />Notice of State Tax Lien <br />2022037 53 <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 duo 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 />97193240 <br />Federal ID Number <br />NO FEIN' <br />Lien Serial Number <br />12299458 <br />Lien filed Wfh: <br />Social Security Number <br />XXX -XX -7214 <br />Spouse's Social Security Number <br />NO SPOUSE SSN <br />04 negIster of Deeds ■ County caerir <br />Date of Lien <br />May 18, 2022 <br />LIen Type' <br />[Corrected <br />County <br />HALL <br />►./ original ■ Continuation <br />Business Name and Location Address <br />Taxpayer Name and Mailing Address <br />DIXANDER GUERRA MARTINEZ <br />1023 OKLAHOMA AVE <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 />11/19/2021 <br />$160.00 <br />$8.00 <br />$4.79 <br />$172.79 <br />Total <br />$172.79 <br />I certify that the Nebraska Department of Revenue has complied with the laws of the State of Nebraska in oetermuherg the amount shown 63 be due, <br />and that the taxpayer flea failed to pay the amount due atter demand. This Notice of Stale Tax Lien is an effective lien and serves to Continua the priority of <br />the State's interest in the affected property of the taxpayer. <br />sign ..�. �:' <br />here Preparees Signature <br />/1.2.914/1., <br />Authorized Signature <br />Revenue Agent 05/16/2022 (306}632-1208 <br />Title Date Phone Number <br />Revenue Supervisor 05/18/2022 <br />Title Date <br />4.494.1974 Rev 9.26la Supeme lee w948.1974 Rau S-2013 <br />