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N_E-134z,Ar fix <br />Go;xr Life. Grea'Serv:<;e. <br />xrrsn4a,A* ervaw <br />NE Sec or State - Robert B. Evnen <br />Filing Document #: 2301000090-3 Pages: 1 <br />Debtor Name: MICHAEL GRAGG <br />Filing Date and Time: 01/05/2023 09:45 AM <br />Notice of State Tax Lien <br />202300056 <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 />39515966 <br />Federal D Number <br />NO FEIN <br />Lion Sobel Number <br />12216447 <br />Lien Filed With <br />Social Security Number <br />XXX -XX -6466 <br />Spouse's Social Security Number <br />XXX -XX -8558 <br />i:'4 Register of Deeds Q County Claris <br />Dale et Lien <br />December 27, 2022 <br />Lien Type: <br />❑Corrected <br />County <br />HALL <br />►i orgaw ❑Contivation <br />Business Name and Location Address <br />Taxpayer Name and Mailing Address <br />MICHAEL GRAGG <br />LORI L GRASS <br />223 EAST 15TH STREET <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 />Individual <br />2017 <br />08/16/2021 <br />$814.89 <br />$107.75 <br />$368.76 <br />$1,291.40 <br />Total <br />$1,291.40 <br />I certify that trio Nebraska Department of Revenue hes complied with the laws of the State of Nebraska in dotermewrg the amount shown to be due, <br />and that the taxpayer has tailed to pay the amount due after demand. This Notice of State Tax Lien is an eflostlee San and servos to contests the priority of <br />the State's interest in the effected property of the taxpayer. <br />� n S <br />herera <br />fTrc�ars Sigrra <br />gnatu <br />Revenue Agent 12/27/2022 (308)632-1208 <br />Title Date Phone Number <br />Revenue Supervisor 12/27/2022 <br />Title Late <br />4-454-1974 Rev -8.2916 supersedes 4.949.1974 Rau 9.2013 <br />