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Good Life, Greet Sarv.cc <br />MUT M M.Nte <br />NE Sec of State - Robert B. Evnen <br />Filing Document #: 2301000610-1 Pages: 1 <br />Debtor Name: LISA LAROSA <br />Filing Date and Time: 01/17/2023 09:53 AM <br />Notice of State Tax Lien <br />202300257 <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 Iien.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 />35454024 <br />Federal ID Number <br />NO FEIN <br />Lien Serial Number <br />12317319 <br />Lien FikW With: <br />Social Security Number <br />XXX -XX -3668 <br />Spouse's Social Security Number <br />NO SPOUSE SSN <br />®Register of Deeds ■ county Clerk <br />Date d Lien <br />January 10, 2023 <br />Lien Type: <br />$525.00 <br />$207.50 <br />County <br />HALL <br />xi original S Continuation <br />■ Corrected <br />usiness Name and Location Address <br />Taxpayer Name a <br />Mailing Address <br />LISA LAROSA <br />3800 HADLEY DR <br />NORTH PLA I i t NE 69101 <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 />2018 <br />12/03/2021 <br />$525.00 <br />$207.50 <br />$116.06 <br />$848.56 <br />Total <br />$848.56 <br />sign <br />here <br />1 pertly that the Nebraska Department of Fievenue has complied with the laws of the State of Nebraska In determining the amount shown so be due, <br />and that the taxpayer has tailed to pay the amount due after demand This Notice of Slaw Tax Lien is an efleetive lien and serves to continue the priority of <br />the State's Interest In the affected property of the taxpayer. <br />Predator's Signature <br />iced Signattfre <br />Revenue Agent <br />Title <br />Revenue Supervisor <br />01/10/2023 (402)471-0987 <br />Date Phone Number <br />01/10/2023 <br />Title Date <br />4-404-la74 Rex.8-2018 Suee!eetles 44441974 Rev. 84013 <br />