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Good Lae. Greet Service. <br />grutpWq OMNI <br />NE Sec of State - Robert B. Evnen <br />Filing Document #: 2206000055-6 Pages: 1 <br />Debtor Name: MICHELLE E ANDERSON <br />Filing Date and Time: 06/01/2022 11:18 AM <br />Notice of State Tax Lien <br />022444079 <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 sien.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 />. <br />Nebraska ID Number <br />97186744 <br />Ferleta1ID Number <br />NO FEIN <br />Lien Serial Number <br />12200032 <br />LenFiled tPAdt• <br />SocialSecwityi Number <br />XXX -XX -1772 <br />Spoosale Social Security Number <br />NO SPOUSE SSN <br />i i Regider of Deeds ■ CousinClerk <br />Date often <br />May 24, 2022 <br />Lien Type: <br />©Corrected <br />County <br />HALL <br />11 Original ■ Comhrmlon <br />Business Name and Loca <br />rens <br />axpayer name an <br />MICHELLE E ANDERSON <br />2204 NORTH HOWARD AVE <br />GRAND ISLAND NE 68803 <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 />2019 <br />08/27/2021 <br />$599.00 <br />$43.30 <br />$55.07 <br />$897.37 <br />Total <br />$697.37 <br />1 certifytbat the Nebraska Department d Ftuvenus has complied with the laws ale Slate of Nebraska in determining the ernaurd strewn Is be due. <br />and That the taxpayer has riled in pay the amount due alter demand. This Notice of State Tax Denis an effective Wast and Serves to continue the prude/ or <br />the State's Merest In the affected property of the taxpayer. <br />Revenue Anent 05/24/2022 (4021471-0987 <br />Tills btu Phan Number <br />Revenue Supervisor 05/24/2022 <br />TIt� Date <br />4454-1e14 Ber5201e 81apas•easase-t5N Pas 84043 <br />