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&q, <br />IU C R t4Y. <br />Li'a. ::'ee' Serv',rn <br />ow....w. a.xva+wr <br />NE Sec of State - Robert B. Evnen <br />Filing Document #!: 2212001101-2 <br />Debtor Name: NICOLAS TOMAS MARTIN <br />Filing Date and Time 12/30/2022 08:56 AM <br />Pages: 1 <br />Notice of State Tax Lien <br />20220U913 <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 wilt 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 />91050510 <br />Federal D Number <br />NO FEIN <br />Lien Serial Number <br />12216456 <br />Lien Filed With. <br />® Register of Deeds ❑ County clerk <br />Social Security Number <br />XXX -XX -2195 <br />Spouse's Social Secunty Number <br />NO SPOUSE SSN <br />Date of ? ien <br />December 27, 2022 <br />Lien Type: <br />$1,000.00 <br />$72.05 <br />County <br />HALL <br />® Original ■ Continuation <br />■ Corrected <br />Business Name and Location Address <br />Taxpayer Name and Mailing Address <br />NICOLAS TOMAS MARTIN <br />916 1/2 BISMARK RD <br />GRAND ISLAND NE 68801 <br />Tax Program <br />Tax Period <br />Date of <br />Assessment <br />Tax <br />Penalty <br />Interest ? Costs <br />I <br />Total Due <br />Individual <br />2020 <br />06/11/2021 <br />$1,000.00 <br />$72.05 <br />$48.41 <br />$1,120.46 <br />Total <br />$1,120.46 <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 />and that the taxpayer has failed to pay the amount due alter demand. This Notice of State Tax Lien is an effective tier. and serves to continue the priority of <br />the Slate's interest in the affected progeny of the taxpayer. <br />Revenue Agent 12/27/2022 (402)471-5833 <br />Prep Si ture `.`' Title Date Phone Number <br />,Y7�^� �jr Revenue Supervisor 12/27/2022 <br />Auttgr�zeddiy tura Title Date <br />4494.1974 Rev. a -Sate Sucerseaas 4.909.1970 Rev. 930'3 <br />