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Good Lite. Great Service e4NO,meer Or Rarer. NE Sec of State - Robert B. Eynon Filing Document #: 2206000360-5 Debtor Name: LUIS R FONSECA MONJES Filing Date and Time: 06/09/2022 09:36 AM Pages: 1 Notice of State Tax Lien This Notice of State Tax lien is Issued by the Nebraska Department of Revenue for unpaid taxes administered by the Tax Commissioner. Taxes, Including penalties, interest, and coats, which are shown below, are due from the taxpayer and remain unpaid after demand.These taxes are a lien for all property located in the county and rights to property owned by the taxpayer or acquired before the expiration of this Ilen.This lien will expire and become unenforceable 10 years after the date of recording if no continuation statement Is recorded on or prior to the expiration of the previous Nen or continuation statement PLEASE DO NOT WRITE omits SPACE Nebraska ID Number 90983873 Federal ID Number NO FEIN Lien Sera) Number 12200591 Lien Filed Wttlt: NI Register of Deeds ❑ County Clerk Social Security Number XXX-XXa223 Spouse's Social Security Number NO SPOUSE SSN Dab d Lien June 2, 2022 Lien 3 pe: GU orquw El Continuation ❑contecbd County HALL us nese Name and Location Address Taxpayer Name and Mailing Address LUIS R FONSECA MONJES 2103 N SYCAMORE DR GRAND ISLAND NE 68801 Tax Program Tax Period Date of Assessment Tax Penalty Interest Costs Total Due Individual 2020 06/11/2021 $820.00 $59.15 $25.68 $904.83 Total $904.83 I certify that the Nebraska Department of Revenue has complied with the laws of the Slate of Nebraska in determlnkva the amount shown b be due, and that the taxpayer has failed to my the amount due atter demand. Thin Notice M Stab Tax Lira Is an effective hen and serves to continue the priorpy of the Stab's interest in the affected property of the taxpayer. sign here Nre Revenue Agent 06/02/2022 (402)471-3712 TM* Dab PhOrte Number Revenue Supervisor 06/02/2022 'zed 'zed Signature Tole Dab 44941974 Rat 64018 Supersedes 4449 19'74 Ran.9,2013