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NE3i4f'T.R7471-.. <br />Good Life. Great Serv.; w. <br />0.41.1.11.1./ 01,111•10FIWE <br />NE Sec of State - Robert B. Evnen <br />Filing Document #: 2303000271-4 Pages: 1 <br />Debtor Name: MICHAEL G CLEGG <br />Filing Date and Time: 03/07/2023 09:14 AM <br />Notice of State Tax Lien <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 Nu er <br />25120743 <br />Federal ID Number <br />NO FEIN <br />Lien Serial Number <br />12322065 <br />Lien Ford Wkh: <br />[Xf Register of Deeds ❑ County Cie rk <br />Social Security Number <br />XXX -XX -9023 <br />Spouses Social Security Number <br />NO SPOUSE SSN <br />Date of Lien <br />March 1, 2023 <br />Lien Type: <br />❑Co«reced <br />County <br />HALL <br />1:1 Original • Continuation <br />Business Name and Location Address <br />Taxpayer Name and Mailing Add <br />MICHAEL G CLEGG <br />1308 W 8TH ST <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 />2018 <br />02/05/2022 <br />$3,405.27 <br />$220.26 <br />$710.33 <br />$4,335.86 <br />Total <br />$4,335.86 <br />1 certify that the Nebraska Department of Revenue hes complied with the laws of the Stale of Nebraska in determining the amount shown to be due, <br />and that the taxpayer has tailed to pay the amount due alter demand. This Notice of State Tax Lien is an effective gen and serves to continue the priorey of <br />the State's interest in the affected property of the taxpayer. <br />sign g.�L, <br />here rProparer's Sig i e <br />L .(%6b <br />Authorized Signature <br />Revenue Agent <br />Title <br />Revenue Supervisor <br />03/01/2023 (308)632-2272 <br />Date Phone Number <br />03/01/2023 <br />Title Date <br />4404.1974 hen 84010 SWaiaccfas 4-945.te74 ray, 5.2013 <br />