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NEBRASKA - <br />Goad <br />Goad Life. Great Service, <br />IMPARIIMITaevvava <br />NE Sec of State - Robert B. Evnen <br />Filing Document #: 2206000882-2 Pages: 1 <br />Debtor Name: JUAN P GIL CORTIZA <br />Filing Date and Time: 06/17/2022 11:32 AM <br />Notice of State Tax Lien <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 Iien.Thia 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 />48432091 <br />Federal <br />NO FEIN <br />0 Bombay <br />Lien Serial Number <br />12201156 <br />Lien riled bl9tth: <br />Social Security Number <br />XXX -XX -7522 <br />Spouse's Social Security Number <br />NO SPOUSE SSN <br />0:4 Reg1s er of Deede ❑ ommy clerk <br />Date of Usn <br />June 10, 2022 <br />, <br />Lien Type: <br />® original D cantirmatlon <br />$59.45 <br />County <br />HALL <br />U Conected <br />us moss Na <br />and Location Address <br />Taxpayer Name and Mailing Address <br />JUAN P GIL CORTIZA <br />831 E OKEECHOBEE RD <br />HIALEAH FL 33010 <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 />$773.43 <br />$59.45 <br />$106.31 <br />$939.19 <br />Individual <br />2019 <br />08/07/2020 <br />$181.00 <br />$9.05 <br />$12.02 <br />$202.07 <br />Total <br />$1,141.26 <br />I certify that the Nebraska Department ot Revenue has complied wth the laws 01 the State ot Nebraska in determining the amount shown to be due, <br />and that the taxpayer has failed to pay the emotes due atter demand. This Notice at State Tax Uen is an effective hen and serves to continue the Monty of <br />the State'sinterest in the affected property or the taxpayer. <br />sign <br />here, Siiggnature [ /J <br />L g 2 <br />Authorized Signature <br />Revenue Anent 06/10/2022 (308)632-1208 <br />Title Data Phone Number <br />Revenue Supervisor 06/10/2022 <br />Tee Dale <br />4494-1974 Rev 92016 Swraedn 4049.1974 Rev. 61913 <br />