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UEBReASKA- <br />Good Lite. Great Serwce. <br />,wMMNrtM•,hM,W <br />202401230 <br />NE Sec of Slate - Robert B. Emeh <br />Filing Document #: 2403000795-8 <br />Debtor Name: GACH T ROM <br />Filing Date and Time: 03/25/2024 11:55 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, end costs, <br />which are shown below, aro due from the taxpayer and remain <br />unpaid atter demand.These taxes ere 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.Thls lien will expire end <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 />9350/196 <br />f seal <br />NO FEIN <br />0 Number <br />lten Swill Number <br />12465006 <br />Lien fled With: <br />Social Seourby Number <br />XXX -XX -0627 <br />Spauer.3ocW Sao" Number <br />NO SPOUSE SSN <br />t7 moor 0(Deo* 0county as* <br />Dab of Uer <br />March 21, 2024 <br />Lien nye: <br />®odpnat 00 olinualIon Qcanr sed <br />County <br />HALL <br />Business Name and Location Address <br />Taxpayer Name and Mailing Address <br />GACH T ROM <br />4196 TEXAS AVE <br />GRAND ISLAND NE 68803 <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 />2022 <br />05/05/2023 <br />5427.00 <br />521.35 <br />519.95 <br />$468.30 <br />Total <br />5468.30 <br />sign <br />here <br />I certify that the Nebres a Department of Revenue ilea complied with the lawn of the Sob of Nebreaka in determining the amount shown is be due, <br />and that the taxpayer has fated to they the amount due tiler demand. This Notice of Sate Tax lien ban elective lien and serves to continua the priority or <br />the Stele's Intone In the elected properly of the taxpayer. <br />Revenue Agent 03/21/2024 (402)471-0987 <br />Prepare,'s Signature lite Date Phone Number <br />Revenue Supervisor 03/21/2024 <br />cited Wpm thh Title Dene <br />4404-iWM Flom tMtMe Superman 4449.1974 Raw.84013 <br />