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202405570 <br />NE Sec of State - Robert B. Evnen <br />Filing Document #: 2411000132-4 Pages: 1 <br />Debtor Name: CORY FULTON <br />Filing Date and Time: 11/04/2024 10:37 AM <br />Good Ufa Goon Senice.. <br />M .1.0.1pI1tYWH <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'hx <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 a8 property located <br />In the county and 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 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 NOTwWTE IN TMis aPACa <br />Nebraska ID NufrAir <br />38849309 <br />Fedi • D Ntaaber <br />NO FEIN <br />Uen SrW Number <br />12489718 <br />Lien FPed Mk <br />®brae ❑yam <br />Sodd 8 Numbr <br />XXX X}f-0481 <br />Spa es See yNtunbr <br />NO SPOUSE SSN <br />5ale of Lien Use Type <br />October 17, 2024 ® "si ❑ s t ❑ Comeded <br />C,rrnty <br />HALL <br />I Wishes* Nato and Location Address ' Taxpayer Name and Mang Address <br />CORY FULTON <br />320 N 1ST APT 34 <br />DONIPHAN NE 68832 <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 />01/27(2024 <br />$1,634.00 <br />$408.50' <br />$443.42 <br />$2,485.92 <br />Individual <br />2018 <br />01/27/2024 <br />$1,164.00 <br />$116.40'. <br />$257.20 <br />$1,537.60 <br />individual <br />2019 <br />01/27/2024 <br />$2,951.00 <br />$737.75 <br />$510.57 <br />$4,199.32 <br />Total <br />$8,222.84 <br />I cagy dad the Nebrula Dammam of Rename hes eanpeed Mth the hoe at the Slele or Neomaela In dolma*** the amount damn et be dim <br />and that the tamp" haWed lo pay the amountdueederdeewmO.TIMNatloealsowTaxUseleene5echeanandwtresboeaanueet.ptbgrat <br />the SWe%Interest Inthe decked peeped, of thetaupayx <br />sign <br />here r MAa614, <br />Authorized S1pmKhae <br />Aro Rqvelue pelt <br />10/17/2024 (308)632-1208 <br />Pion Number <br />Revenue Supervisor 10/17/2024 <br />TMe Dale <br />441114$74 Iw soots srveee+.. 4074 Art 0.2019 <br />