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INEE3Rr,4s 4A <br />Good Life. Greet Service. <br />IMVATININ. or•w,.u, <br />202.402166 <br />NE Sec of State - Robert B. Evnen <br />Filing Document #: 2405000369-5 <br />Debtor Name: 1RANDY FERNANDEZ <br />Filing Date and Time: 05/15/2024 09:56 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 area 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 IIen.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 INTMLS SPACE <br />Nebraska ID Number <br />94576157 <br />Federal 10 ['ember <br />NO FEIN <br />USA Sartal Number <br />12471748 <br />lien Fiied With <br />Social Seaway Number <br />X00X.XX.2546 <br />Spouse's Social Security Number <br />NO SPOUSE SSN <br />1:c Register of Deeds ❑Coteaycierk <br />Deo of (len <br />May 7, 2024 <br />Lien type: <br />® Original Gontinuaaon ©corrected <br />County <br />HALL <br />liness Name and Location Address <br />expel/et Name and halting Address <br />(RANDY FERNANDEZ <br />2222 BELLWOOD DR APT 105 <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 />2017 <br />10/03/2023 <br />$2,060.00 <br />$515.00 <br />$513.03 <br />$3,088.03 <br />Individual <br />2018 <br />10/03/2023 <br />$1,153.00 <br />$288.25 <br />$245.92 <br />$1,687.17 <br />Total <br />$4,775.20 <br />sign <br />here <br />I certify that the Nebraska Oeperlment of Revenue has complied with the laws of the Stab of Nebraska In da mnrininp the amount shone b be due. <br />and lust the taxpayer has felled to pay the amount due after demand. 'this Nature of Stab Tax Lien is an effective Nen and senna to continua the priority of <br />the Ststet Interest in the affected property of the taxpayer. <br />> Revensee Aoent Q5(07/2024 (4021471-5712 <br />Signature /� <br />'nue phone Number <br />�.� __. ✓. Revenue Supervise 05/07/2024 <br />:zed Signature Tile Dab <br />4-Is4tem Rn,. e•1aa aipe,pdes 44404574 Asw.asaa <br />