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NEBRASKA - <br />Good Life. Great Service. <br />,111MeM1•11 M UMW„ <br />NE Sec of State - Robert B. Evnen <br />Filing Document #: 2402000656-1 Pages: 1 <br />Debtor Name: WILBER A GOMEZ <br />Filing Date and Time: 02/20/2024 10:36 AM <br />Notice of State Tax Lien <br />202400712 <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 costa, <br />which aro 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 end 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 mottling 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 wraTE IN THIS SPACE <br />Nebapia ID Number <br />40942368 <br />Federal <br />NO FEIN <br />0 Number <br />Lien Sete Number <br />12480982 <br />Use Flied With: <br />Sade saaoky Number <br />XXX-XX4I 91 <br />*muse's Social Security Number <br />NO SPOUSE SS/4 <br />1;4 Review of Deeds 0 County Clerk <br />Dela *Mien <br />February 15, 2024 <br />Lien type: <br />m Orgbr 0 Cominuanwr <br />$276.25 <br />County <br />HALL <br />■ cone led <br />Business Name and Location Address <br />Taxpayer Name and Mailing Address <br />WILBER A GOMEZ <br />562 E 18TH 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 />08/1812023 <br />$1,113.00 <br />$276.25 <br />$264.68 <br />$1.655.93 <br />Individual <br />2020 <br />08/182023 <br />$280.00 <br />$70.00 <br />$29.42 <br />$379.42 <br />Individual <br />2021 <br />06/1812023 <br />$504.00 <br />$126.00 <br />$39.15 <br />$669.15 <br />Total <br />$2,704.50 <br />1 certify that the Nebraska Department of Revenue has complied with the laws of the ate of Nabraaa. In determining the amount shown a be due, <br />and that ane taxpayer has hied to pay the amount due akar damand.Thls Notice of State Tao Lien is an elective len and serves to continue the prbray of <br />the Stal's interest In the enacted properly of the taxpayer, <br />sign <br />here r Pnilmere t3lynature <br />Revenue Agent 021152024 (402)471-5788 <br />Title Doh Phone Number <br />Revenue Supervisor 02/15/2024 <br />Tine Date <br />ddW-,ala her. 6.2015 Suee meds 4440.1074 Mw 04013 <br />