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Go .l Life. Great Sere -:;e. 202302503 NE Sec of State - Robert B. Evnen Filing Document #: 2305000826-6 Pages: 1 Debtor Name: AMED LOPEZ PEREZ Filing Date and Time 05/24/2023 10:55 AM Notice of State Tax Lien This Notice of State Tax Lien is issued by the Nebraska Department of Revenue for unpaid taxes administered by the Tax Commissioner. Taxes, Including penalties, interest, and costs, which are shown below, are due from the taxpayer and remain unpaid after demand.These taxes are a lien for all property located in the county and rights to property owned by the taxpayer or acquired before the expiration of this lien. This lien will expire and become unenforceable 10 years after the date of recording N no continuation statement is recorded on or prior to the expiration of the previous lien or continuation statement. PLEASE DO NOT WRITE INTHIS SPACE Nebraska ID Number 93289501 Federal ID Number NO FEIN Lien Serial Number 12332182 Lien Filed With: Social Securky N mnber XXX -XX -4454 Spouse's Social Security Number NOSPOUSE SSN l;4Register ofDeeds ©County Clerk Date o1 Lien May 15, 2023 Lien Type: 0Correctsd Courtly HALL Iii original EliConbnualon usiness Name and Location Address Taxpayer Name and Mailing Address AMED LOPEZ PEREZ 411 WEST DIVISION STREET GRAND ISLAND NE 68801 Tax Program Tax Period Date of Assessment Tax Penalty Interest Costs Total Due Individual 2021 11/15/2022 $1,020.00 $59.52 $40.66 $1,120.18 Total $1,120.18 sign here f certify that the Nebraska Department of Revenue has complied with the lees o1 the State of Nebraska In determining the amount shown lo be due, and that the taxpayer has tailed to pay the amount due alter demand. This Notice of State Tax Llan is en eflocOve lien and serves to continue the priority of the State's interest in the amect d properly of the taxpayer, Revenue Aaent 05/15/2023 (308)632-1206 Title Dale Phone Number Revenue Supervisor 05/15/2023 Title Date 4-494-1974 Ren, 8.2018 Superaedas 4949.1974 Flea 6-2019