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Good Lits. Great Service. <br />.e*...e,r a.1111...,. <br />NE Sec of State - Robert B. Evnen <br />Filing Document #: 2409000654-6 Pages: 1 <br />Debtor Name: GUSTAVO R ACOSTA HERNANDEZ <br />Filing Date and Time: 09/27/2024 09:22 AM <br />Notice of State Tax Lien <br />202404776 <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.Thls 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 INT IS SPACE <br />Nebraska ID Number <br />49008048 <br />Pedanl <br />NO FEIN <br />0 Number <br />Lien Sail Number <br />12488102 <br />Lien Flied With: <br />0/1 Register of Deeds ❑ County Cie n <br />Sudel Seca ty Number <br />xXX.XX-9102 <br />Spouse's Sold Security Number <br />NO SPOUSE SSN <br />Dale of Lien <br />September 18, 2024 <br />Lien Type: <br />®onginai ❑Continration DConeoted <br />C9ieey <br />HALL <br />us nese Name and Location Address <br />Taxpayer Name and Mailing Address <br />GUSTAVO R ACOSTA HERNANDEZ <br />1408 W 5TH 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 />2022 <br />07/21/21923 <br />$1,655.00 <br />$82.75 <br />$118.34 <br />$1,856.09 <br />Total <br />$1,856.09 <br />sign <br />here <br />I certify that Ire Meanie Department of Revenue has complied with the taws of to Stele of Nebraska hr detamnlnmg the amount shown to be duo,. <br />and that the lesprpmr Ilea pled lo pay the ammtsd due alter demand. TN* Notice of State TM len N an sdecd.e lien end semi to condom the priority of <br />lb. State's interest it the elected property of the unsyer. <br />ars Signature <br />orlsad Signaler. <br />Revenue Agent_ 09/18/2024 1402}471-5928 <br />Tide Date Phone Number <br />Revenue Supervisor 09/18/2024 <br />mid Date <br />4.4944974 IM, 5.2015 euewmd.a 4-046.1574 ROI . 84913 <br />