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NEBRASKA - <br />Good Life. Great Service. <br />06".11/14111141, OP •MVP6.1{ <br />202301334 <br />NE Sec of State - Robert B. Evnen <br />Filing Document #: 2303000877-2 Pages: 1 <br />Debtor Name: ANTONIO A BELTRAN <br />Filing Date and Time: 03/21/2023 11:03 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 Number <br />47469110 <br />Federal D Number <br />NO FEIN <br />Lien Serial Number <br />12323667 <br />Lien Filed With; <br />Sodas Security Number <br />XXX -XX -6790 <br />Spouses Social Security Number <br />NO SPOUSE SSN <br />i7 Register of Deeds • county Cleric <br />Date of Lien <br />March 14, 2023 <br />Lien Type: <br />$1,256.00 <br />$428.50 <br />County <br />HALL <br />E4 Original El Continuation <br />■ Corrected <br />e and Location Address <br />Taxpayer Name and Mailing Address <br />ANTONIO A BELTRAN <br />1611 SYLVAN 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 />2020 <br />07/19/2022 <br />$1,256.00 <br />$428.50 <br />$85.00 <br />$1,769.50 <br />Total <br />$1,769.50 <br />sign <br />here <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 that the taxpayer has failed to pay the amount due after demand. This Notice of State Tar Lien is an effective lien and serves to continue the priority of <br />the States interest in the affected property of the taxpayer. <br />Preparers Signalur <br />prized Signa <br />Revenue Senior Agent <br />Title <br />Revenue Supervisor <br />03/14/2023 (402)471-4339 <br />Dale Phone Number <br />03/14/2023 <br />Title Date <br />4-494-1974 Fiev. 8-2018 %penme x 4.9491974 Rev 8-2013 <br />