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N,LiiRAG-KA <br />cxcd Life, Great Service. <br />OWOlrMM Or INV.. f <br />202301871 <br />NE Sec of State - Robert B. Evnen <br />Filing Document #: 2304000797-6 Pages: 1 <br />Debtor Name: JUAN A GUZMAN GOMEZ <br />Filing Date and Time: 04/18/2023 10:02 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 Tien. This lien will expire and <br />become unenforceable 10 years after the date of recording N no <br />continuation statement is recorded on or prior to the expiration of <br />the previous lien or continuation statement. <br />PLEASE 00 NOT WRITE IN THIS SPACE <br />Nebraska 10 Number <br />99299402 <br />Federal 0 Number <br />NO FEIN <br />Lien Serial Number <br />12327090 <br />Lien Feed With: <br />® Register of Deeds ❑County Clerk <br />Social Seaway Nunes <br />XXX -XX -2773 <br />Spouse's Social Security Number <br />NO SPOUSE SSN <br />Date of Lien <br />April 11, 2023 <br />Lien Type: <br />®Original ❑Continuation ❑Corrected <br />County <br />HALL <br />slnesa Name and Location Address <br />Taxpayer Name and Mailing Address <br />JUAN A GUZMAN GOMEZ <br />1008 W 7TH 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 />2021 <br />05/27/2022 <br />$2,632.00 <br />9229.84 <br />$113.31 <br />$2,975.15 <br />Total <br />$2,975.15 <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 faded to pay the amount due after demand. This Notice of State Tax Lien is an effective lien and serves to continue the priority of <br />Me State% Interest in the affected property of the taxpayer. <br />Preparers Signature <br />prized Signatufa <br />Revenue Agent <br />The <br />Revenue Supervisor <br />04/11/2023 (402)471-6043 <br />Dale Phone Number <br />04/11/2023 <br />Title Dae <br />4-4841974 Rep. 84018 Supersedes 44149.1974 Rar. 8-2013 <br />