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Ni,., laRA':3TSJ6k'-- <br />Good Lite. Great Service <br />11x1.R044,47M PRV4eVR <br />NE Sec of State - Robert B. Emen — '- <br />Filing Document #: 2308000794-5 Pages: 1 <br />Debtor Name: NICHOLAS A BERGER <br />Filing Date and Time 08/25/2023 11:07 AM <br />29 <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 NDTWRITE IN THIS SPACE <br />Nebraska ID Number <br />97784669 <br />Federal ID Number <br />NO FEIN <br />Lien Serial Number <br />12343531 <br />Lien Feed With: <br />Som Secwhy Number <br />XXX -XX -2896 <br />Spauae'S Social Security Number <br />NO SPOUSE SSN <br />rri Register of Deeds j;] County Clerk <br />Date of Lien <br />August 17, 2023 <br />Lien Type: <br />® Original ❑Cormm,ation ©CcMected <br />County <br />HALL <br />Business Name and Location Address <br />Taxpayer Name and MaII ng Address <br />NICHOLAS A BERGER <br />915 W 3RD 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 />03/24/2023 <br />$622.00 <br />$31.10 <br />$32.80 <br />$685.90 <br />Total <br />$685.90 <br />sign <br />here <br />I certify that the Nebraska Department of Revenue has complied wIN the laws of the State of Nebraska In determining the amount shown to be due. <br />nd that the taxpayer has heed to pay the amount due after demand This Notice of State Tax Lien h an eltecti`e lien and serves to continue the priority of <br />the State's i terest m the affected properly at the taxpayer. <br />Authorized Signature <br />Revenue Senior Anent 08/17/2023 (308)632-1203 <br />The Date Phony Nwrber <br />Revenue Supervisor 08/17/2023 <br />Title Date <br />4.4e44974 Per 9-201e Suaeardse 4440.1974 Hee. 54013 <br />