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ISI C R _A - <br />Good Lifa. Great. Service. <br />o....,wh.e. <br />NE Sec of State - Robert B. Evnen <br />Filing Document #: 2206000883-1 Pages: 1 <br />Debtor Name: VINCENT T MENDEZ III <br />Filing Date and Time: 06/17/2022 11:33 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 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 statemenL <br />PLEASE DO NOT WRITE IN THIS SPACE <br />Nebraska ID Number <br />37787888 <br />Federal ID Number <br />NO FEIN <br />Llan Serial Number <br />12201106 <br />Llan PNDWith, <br />Social. Security Number <br />XXX -XX -6058 <br />Sp ouseb Social SoCurfip Number <br />NO SPOUSE SSN <br />i7' Register of Deeds ❑ County Clerk <br />Date of Lien <br />June 9, 2022 <br />Lien Type: <br />❑Comtcted <br />County <br />HALL. <br />!:f Orval& ❑Corntinutdon <br />Business Name and Location Address <br />Taxpayer Name and Mailing Address <br />VINCENT T MENDEZ III <br />116 CHEROKEE 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 />08/06/2021 <br />$373.00 <br />$18.65 <br />$24.73 <br />$416.38 <br />Total <br />$416.38 <br />I certify that the Nebraska Department of Revenue has complied with the laws el the State of Nebraska In determining the amount slew to be due. <br />and thal the taxpayer has tailed to pay the amount due after demand. This Notice of Slate Tax Lien Is an effectie lien and serves to continue fie prbety of <br />the Stele's interest In the affected properly of the taxpayer. <br />sign 44,64,a <br />.6141here rieparefsSigmttire <br />Authorized S.gnslure <br />Revenue Agent 06/09/2022 (308)632-1201 <br />Tale Date Rhone Number <br />Revenue Supervisor 08/09/2022 <br />Tree Date <br />44041974 Rev. 8-201811¢0026:1811 4.9461474 Ren 94013 <br />