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Ga -,t Lite. Creat Sef,fe. <br />RIMIMMIg <br />202208437 <br />NE Sec of State • Robert B. Evnen <br />Filing Document #: 2212000239-7 Pages: 1 <br />Debtor Name: ERIC N MCCOOL <br />Filing Date and Time: 12/07/2022 10:13 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 MI THIS SPACE <br />Nebraska ID Number <br />9282181 <br />Federal ID Number <br />203400553 <br />Lien Serial Number <br />12213188 <br />Lien Filed With: <br />® Register of Deeds D County Clerk <br />Social Security Number <br />XXX -XX -4347 <br />Spouse's Social Security Number <br />NO SPOUSE SSN <br />Date of Lien <br />November 10, 2022 <br />Lien Type: <br />EDCorrected <br />County <br />HALL <br />I Original a Continuation <br />Business Name and Location Address <br />Taxpayer Name and Mailing Address <br />ERIC N MCCOOL <br />1104 W 12TH ST <br />GRAND ISLAND NE 68801 <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 />0 1101/2020 •08/31/2022 <br />11/01/2022 <br />863.93 <br />725.00 <br />74.37 <br />300.00 <br />1,963.30 <br />Total <br />1,963.30 <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 />and that the taxpayer has failed to pay the amount due of et demand. This Notice of State Tax Lien is an effective lien and serves to continue tie priority of <br />the State's in� in the affected properly of the taxpayer. <br />sign job G�i1Li Revenue Agent %%`.��didt�.9" f02-370-3345 <br />here Preparer s Sig rg Tile Dale Phone Number <br />Revenue Supervisor /f <,zf='zYstsr <br />Authorized Signature <br />Title <br />Date <br /><494.1974 Here 8-2078 Suriereedes 4.919-1974 Rev. 8-2013 <br />