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Good Life. tsreee Service. <br />wOMOTht.x, ar=vars. <br />NE Sec of State - Robert B. Evnet <br />Filing Document #: 2301000920-5 Pages: I <br />Debtor Name: CHRISTOPHER WILLIAMS <br />Filing Date and Time: 01/23/2023 08:52 AM <br />Notice of State Tax Lien <br />202300345 <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 />44404948 <br />Federal D Number <br />NO FEIN <br />Lien Serial Number <br />12317675 <br />Llen Frtad with: <br />Social Security Number <br />XXX -XX -4i8$ <br />Spouse's Social Security Number <br />NO SPOUSE SSN <br />14 Mar of Deeds 0County Clerk <br />Dale of Lien <br />January 13, 2023 <br />Len Type: <br />County <br />HALL. <br />t;1 Original 0corgirunion <br />■ Corrected <br />ass <br />Taxpayer Name and Mailing Address <br />CHRISTOPHER WILLIAMS <br />108 LAKEVIEW CIRCLE APT 11 <br />GRAND ISLAND NE 68803 <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 />2015 <br />01/20/2021 <br />$129.95 <br />$303.50 <br />$282.68 <br />$716.13 <br />Individual <br />2016 <br />01/20/2021 <br />$829.00 <br />$293.75 <br />$237.57 <br />$1,360.32 <br />Individual <br />2017 <br />01/20/2021 <br />$1,327.00 <br />$331.75 <br />$243.22 <br />$1,901.97 <br />Total <br />$3,978.42 <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 Net The taxpayer has failed to pay the amount due after demand. This Notice of State Tax Lien fa a t efecthe lien and serves to continue the priority of <br />the State's interest in the effected property of the taxpayer. <br />sign $ritdyef-Martin, <br />here Preparer's Signature <br />Authorized Signature <br />Revenue Agent 01/13/2023 (308)632-1210 <br />Tide Date Phone Number <br />Revenue Supervisor 01/13/2023 <br />Title Dale <br />4490574 Rev. 84018 Supersedes 4.949.1974 Rev. 64013 <br />