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BRAT •KA— <br />Goad Life. Great Service. <br />202306760 <br />NE Sec of State - Robert B. Evnen <br />Filing Document #: 2312000749-8 Pages: 1 <br />Debtor Name: JEFF GREENWALT <br />Filing Date and Time: 12/28/2023 08:42 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 deme nd.These taxes area lien for all properly located <br />in the county and rights to property owned by the taxpayer or <br />acquired before the expiration of this lien.This Nen 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 TINS SPACE <br />Nebraska ID Number <br />25796356 <br />Federal D Number <br />NO FEIN <br />Lar Serial Number <br />12355932 <br />tan Fred With: <br />® o of oeed: 0 y ctertr <br />Social Security Number <br />XXX -XX -3010 <br />Spouse's Social Security Number <br />XXX -XX -2620 <br />Dale of Llan <br />December 15, 2023 <br />t.ien Type; <br />Xl original 0continuaten I0Corrected <br />County <br />HALL <br />us nese Name and Location Address <br />axpayer Name an Malung <br />JEFF GREENWALT <br />LOIS A GREENWALT <br />206 VALLEY DR <br />PHILLIPS NE 68865 <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 />2016 <br />09/11/2023 <br />$20,992.00 <br />$5,248.00 <br />$5,443.54 <br />$31,683.54 <br />Individual <br />2017 <br />09/11/2023 <br />51,432.00 <br />$358.00 <br />$328.38 <br />$2,118.38 <br />Individual <br />2019 <br />09/11/2023 <br />$14,156.00 <br />$3,539.00 <br />$1,853.85 <br />$19,548.85 <br />Individual <br />2020 <br />09/11/2023 <br />$1,953.00 <br />$488.25 <br />$188.56 <br />$2,629.81 <br />Individual <br />2021 <br />09/11/2023 <br />$3,347.00 <br />$836.75 <br />$231.54 <br />$4,415.29 <br />Total <br />$80,395.87 <br />sign <br />here <br />I certify Mad the Nebraska Deperenenl of Nevem* has complied with the laws of the SUN of Nebraska In determining the amount shown to be due. <br />and that the taxpayer has fated to pay Ida amount dor akar demand. Ma Notice or State Tax Lan IS an decttve pan and serves to continue le priority of <br />the Sate'. interest In the opened property of the trauma'. <br />, Yrd Revenue Senior Anent 12/15/2023 (308)632-1203 <br />','twef... 7% Tile Date Phone Number <br />..a �1e�� Revenue Supervisor 12/15/2023 <br />Authorized Signature Tile <br />Date <br />4141 -tam nor. Prone Supa+waw 441E ISM lax 04013 <br />