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SEA <br />Good Lee. Great Seeace. <br />201303238 <br />NE Sec of State - Robert B. Evnen <br />Filing Document #: 2306000842-3 Pages: 1 <br />Debtor Name: DAMIAN RODRIGUEZ <br />Filing Date and Time: 06/28/2023 11:30 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 Iien.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 00 NOT WRITE IN THIS SPACE <br />Nebraska ID Number <br />91624770 <br />Federal ID Number <br />NO FEIN <br />Lien Serial Number <br />12336914 <br />LIe1 F11ed With: <br />Social Security Number <br />XXX -XX -6235 <br />Spouse$ Social Security Number <br />NO SPOUSE SSN <br />i1 Register 01 Deeds ■ County clerk <br />owe o1 Len <br />June 22, 2023 <br />Lien Type: <br />® Original 0Continuatkm 0Corrected <br />fumy <br />HALL <br />Business Name and Location Address <br />axpayer Name and Mailing Addroes <br />DAMIAN RODRIGUEZ <br />APT B <br />1310 E 5TH 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 />2019 <br />09/21/2022 <br />$1,252.00 <br />$62.60 <br />$133.78 <br />$1,448.38 <br />Total <br />$1,448.38 <br />I certify mal the Nebraska Department of Revenue has complied with the taws of the State of Nebraska In determining the amount shown to be due, <br />and that the taxpayer hu tailed to pay me amount due after demand. This Notice of State Tax Lien is en effective Wen and serves to continue the priority of <br />the State's Interest In the affected property 01 the taxpayer. <br />sign <br />herePreparers Signature <br />ed Signet, <br />Revenue Agent 06/22/2023 (402)471-5788 <br />Tide Dale Phone Number <br />Revenue Supervisor 06/22/2023 <br />Title Date <br />4994-1974 Rev.8.2078 Supersedes 4.949.1974 REM 84013 <br />