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Good Life. Great Service.. <br />ew.weer.re w�tw.va <br />202303685 <br />NE Sec of State - Robert B. Evnen <br />Filing Document #: 2307000634-5 <br />Debtor Name: LUIS M HERRERA <br />Filing Date and Time: 07/21/2023 10:35 AM <br />Pages: 1 <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 />89630513 <br />Fed ral. 0 Number <br />NO FEIN <br />Lien Seoul Number <br />12339867 <br />Llon Filed With: <br />Soolal Security Number <br />XXX -XX -2940 <br />Spouo a Social Security Number <br />NO SPOUSE SSN <br />i7 Register of Deeds ❑ county Clerk <br />Date of Len <br />July 19, 2023 <br />I <br />Lien Type: <br />L(ilriginal E] Continuation ❑corrected <br />Courcy <br />HALL <br />usiness Name and Location Address <br />Taxpayer Name and Mailing Address <br />LUIS M HERRERA <br />111 N EDDY 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 />07/12/2022 <br />$522.53 <br />$18.80 <br />$48.12 <br />$589.45 <br />Total <br />$589.45 <br />I certify that the Nebraska Department of Revenue has complied with the laws of the State of Nebraska Er determining the amount shown to be due. <br />end that the taxpayer has failed to pay me amount due after demand. This Notice of Slate Tax Uen Is en effective lien and serves to continue the priority of <br />the State's interest in the affected property of the taxpayer. <br />Sign ` <br />here r Preeparer'cSrgnatur <br />} rthorized Sign <br />Revenue Agent 07/19/2023 (402)471-5788 <br />Title Date Phone Number <br />Revenue Supervisor 07/19/2023 <br />Vile Date <br />4-094-1974 Flea aaote Supersedes 4.949.1974 Per, 5-2013 <br />