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NEEIRASVSAM <br />Good Lift'. Groat Service, <br />xr.•xawr cur avuwr <br />NE Sec of State . Robert B. Evnen <br />Filing Document #: 2212001129-8 Pages: 1 <br />Debtor Name: SHANDI HARTWIG <br />Filing Date and Time: 12/30/2022 10:23 AM <br />Notice of State Tax Lien <br />202208914 <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 tttTHIS SPACE <br />Nebraska ID Number <br />43100570 <br />Federal <br />NO FEIN <br />D Number <br />Lien Serial Number <br />12216432 <br />Lien Fwd With <br />® Register of Deeds ❑ County Clerk <br />Social Security Number <br />XXX -XX -6983 <br />Spouse's Social Security Number <br />NO SPOUSE SSN <br />Date of Lien <br />December 22, 2022 <br />Lien Type: <br />® on9inal ❑ Continuation ❑ Corrected <br />County <br />HALL <br />Business Name and Location Address <br />Taxpayer Name and Mailing Address <br />SHANDI HARTWIG <br />508 CONEFLOWER <br />GRAND ISLAND NE 68603 <br />Tax Program <br />Tax Period <br />Date of <br />Assessment <br />Tax <br />Penalty <br />Interest <br />Costs <br />Total Due <br />Individual <br />2020 <br />06/11/2021 <br />$991.00 <br />$49.55 <br />$47.57 <br />$1,088.12 <br />Total <br />$1,088.12 <br />I certify that the Nebraska Department of Revenue has complied with the taws of the State of Nebraska a, 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 lien and serves to continue the platy of <br />the States interest In The affected property of the axpaym. <br />sign <br />here r Preparer <br />• <br />Autho <br />e512.442, 714 <br />Revenue Ascent <br />Title <br />Revenue Supervisor <br />Title <br />12/22/2022 (308)632-1208 <br />Date <br />Phone Number <br />12/22/2022 <br />Date <br />4494.1974 Rev. 8.2018 Supersedes 4491874 Rev. 11-2013 <br />