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NEBRASKA <br />- <br />Good L Ie. Great Seroce. <br />OV ittle..111 <br />NE Sec of State - Robert B. Evnen <br />Filing Document #: 2205000960-0 Pages: 1 <br />Debtor Name: TIMOTHY D MILES <br />Filing Date and Time: 05/20/2022 11:00 AM <br />Notice of State Tax Lien <br />202203 754 <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 ilen.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 />69120809 <br />Federal D Number <br />NO FEIN <br />Lron Serial Number <br />12299546 <br />Lien Filed Web: <br />Social Security Number <br />XXX -XX -4081 <br />Spouse's Social Security Number <br />XXX -XX -6780 <br />l:4 Register of Deeds D County Die rk <br />Date of Lien <br />May 17, 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 />TIMOTHY D MILES <br />JACQUELINE S MILES <br />2323 BELLWOOD DR APT 118 <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 />06/11/2021 <br />$341.00 <br />$17.05 <br />$10.23 <br />$368.28 <br />Total <br />$368.28 <br />I certify that the Nebraska Department of Revenue has complied with the laws of the State of Nebraska in determining the amount shown to be due, <br />end that ale taxpayer has tailed to pay the amount due after demand This Notice of State Tax Lien Is en effective Lien and serves to continue 9+e priority of <br />the Slate% interest in the affected property of the taxpayer. <br />sign xla ,Levee <br />here, emperors Si lure <br />.L.¢r z. A/104A <br />Authorized Signature <br />Revenue Agent 05/17/2022 (308)632-1201 <br />Tale Data Phone Number <br />Revenue Supervisor 05/17/2022 <br />Title Date <br />4.4844874 rev. a -sole 8r*e19edee 4.9494974 rev. 99013 <br />