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NIEBRA-SKA <br />Lrte, e. <br />apur+nMMr oe R£'V.. <br />202205882 <br />NE Sec of State - Robert B. Evnen <br />Filing Document #: 2208000396-8 <br />Debtor Name: LEE E SHAVER <br />Filing Date and Time: 08/09/2022 10:32 AM <br />Pages: 1 <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 lien. 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 />47308648 <br />Fe eral ID Number <br />NO FEIN <br />Lien Serial Number <br />12205261 <br />Date of Lien <br />August 5, 2022 <br />Lien -I Filed With: <br />IX1 Register of Deeds O County Clerk <br />Lien Type: <br />Original Continuation <br />E3 <br />Socket Security Number <br />XXX -XX -5803 <br />Spouse's Socias Security Number <br />NO SPOUSE SSN <br />0 Corrected <br />County <br />HALL <br />Business Nam <br />and Location Address <br />Taxpayer Name and Mailing Address <br />LEE E SHAVER <br />2605 FORREST ST <br />GRAND ISLAND NE 68803 <br />Tax Program <br />Tax Period <br />Date of <br />Assessment <br />Tax <br />Penalty <br />Interest 1 Costs <br />Total Due <br />[,_ Individual <br />2019 <br />10/02/2020 <br />$443.001 $66.45 <br />531.451 <br />$540.90 <br />Total <br />5540.90 <br />I cooly that the Nebraska Department of Rononue has comr,ued with the laws of the State of Nebraska in determining the amount shown to be due.. <br />and that the taxpayer has failed to pay the amount due biter demand. This Notice of State Tax Lien is an effective ties and serves to continue the priority of <br />the State's Interest a the atlected properly re the taspayet. <br />sign�__-rT 94 <br />here PreparSi9na€we <br />Revenue Agent <br />This <br />Revenue Supervisor <br />08/0512022 0021471-5833 <br />Date Phone Number <br />08/05/2022 <br />Tide <br />Date <br />4uan-197a SIxv, 6.2til0 Supoaaoes 4•9‘9•14 24 Rev. 84013 <br />