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202206624
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9/13/2022 3:24:19 PM
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9/13/2022 3:24:19 PM
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202206624
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a)% <br />N E Qom... <br />Oe•All•Ntrir slava.* <br />202206624 <br />NE Sec of State - Robert B. Evnen <br />Filing Document #: 2209000521-1 Pages: 1 <br />Debtor Name: JUSTIN L COUCH <br />Filing Date and Time: 09/13/2022 12:09 PM <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 />12020699 <br />Federal D Number <br />272541950 <br />Lien Serial Number <br />12210267 <br />Lien Filed With: <br />Social Security Number <br />XXX -XX -9301 <br />Spouse's Social Security Number <br />NO SPOUSE SSN <br />b Register of Deeds ECounty Clerk <br />Date of Lien <br />July 15, 2022 <br />Lien Type: <br />Orkpnat D continuation ❑Corrected <br />County <br />HALL <br />usiness Name and Location Address <br />Taxpayer Name and Mailing Address <br />JUSTIN L COUCH <br />2721 STEWART DR <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 />Sales <br />04/01/2016-07/31/2016 <br />03/27/2022 <br />1,900.00 <br />380.00 <br />419.82 <br />.00 <br />2,699.82 <br />Total <br />2,699.82 <br />sign <br />here <br />I certify that the Nebraska Department of Revenue has complied with the laws of the State of Nebraska in determining the amount shown to be due, <br />ana that the J.attpayer has failed to pay the amount due after demand. This Notice of State Tax Lien is an effective ken and nerves to oommue the priority of <br />the Slabest 'm the affected proygrty4l the taxpayer. <br />Revenue Agent 07/08/2022 402-471-5711 <br />es Signature f f -- Title Date Phone Number <br />C` aver,:R. V Revenue manager 07/08/2022 <br />r3�+ <br />Title Date <br />4-494-1974 nov. a-26'4 Suporsedos 4449.1974 Rev. 6.20/3 <br />Aulnurized Si. atare <br />
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