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Cron,:I L'.i l/rni:n Sere r r. <br />207 n6373 <br />NE Sec of State - Robert B. Evnen <br />Filing Document #: 2208001047-2 Pages: 1 <br />Debtor Name: SHANE F HIGGINS <br />Filing Date and Time: 08/30/2022 10:07 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 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 />22812091 <br />Federal 0 Number <br />NO FEIN <br />Lien Serial Number <br />12206485 <br />Lien Filed With: <br />Social Security Number <br />XXX -XX -8683 <br />Spouses Social Security Number <br />XXX -XX -3808 <br />® Register of Deeds ■ County Clerk <br />Date W Lien <br />August 23, 2022 <br />1 <br />Lien Type: <br />El Original [JContawatan QCorrected <br />County <br />HALL <br />usiness Name and Location Address <br />Taxpayer Name and Mailing Address <br />SHANE F HIGGINS <br />DARLENE K HIGGINS <br />3335 PRIMROSE DRIVE <br />GRAND ISLAND NE 68801 <br />Tax Program I Tax Period <br />1 <br />Date of <br />Assessment <br />Tax <br />Penalty <br />Interest <br />Costs <br />Total Due <br />Individual 2015 <br />08/14/2021 <br />$4,411.00 <br />$1,102.75 <br />$1,018.16 <br />$6,531.91 <br />Individual Ii 2018 <br />08/14/2021 <br />$4,802.00 <br />$1200.50 <br />$648.60 <br />$6,651.10 <br />Total <br />$13,183.01 <br />I certify That the Nebraska Department of Revenue has complied with the taws of the State of Nebraska in determining the anloum shown to be due, <br />end that the taxpayer has failed to pay the amount due alter demand, This Notice of State Tax Lienis an effective lien and serves to continue the priority of <br />the State's Interest in the affected property of the taxpayer. <br />sign Zez-y'Revenue Agent 08/23/2022 (402)471-5833 <br />here Prepn Signature Tide Date Phone Number <br />Revenue Supervisor 08/23/2022 <br />Authorized Signature Title Date <br />4454.1974 hey. 0-20,13 Supe-sede44.aoa.r974Rev. 0.2013 <br />