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NE Sec of State - Robert E. Evnen <br />Filing Document #: 2503000370-2 <br />Debtor Name: CARLOS SANDOVAL JR <br />Filing Date and Time: 03/10/2025 09:34 AM <br />2G2501204 <br />Pages: 1ga: 1 <br />Good Lde. Greet Serve. <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 dernand,These taxes ars a Hen 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,This lien will expire and <br />become unenforceable 10 years after the date of recording if no <br />continuation statement la recorded on or prior to the expiration of <br />the previous Nen or continuation statement <br />PLEASE DO NOT WRITE NtTHIS SPACE <br />Nebraska ID Number <br />96028351 <br />Federal 10 NumWr <br />NO FEIN <br />Lien SerW Number <br />12598761 <br />Lien Filed Mk <br />®rtsy;sisrotDesee <br />❑county Clerk <br />Soelal $eowaYNumber <br />XXX-XX-1608 <br />Spouse's Social Security Number <br />NO SPOUSE SSN <br />Date of Lien <br />February 21, 2025 <br />1 y ' <br />Llen hips: <br />XI ortina <br />Qconaiusdon • Corrected <br />County <br />HALL <br />ODD ON AOdress <br />Name and Mailing Address <br />CARLOS SANDOVAL JR <br />215 E KOENIG 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 />2018 <br />05/26/2024 <br />$10,638.00 <br />$2,659.50 <br />$2,737.03 <br />$16,034.63 <br />Individual <br />2020 <br />0528/2024 <br />$9,224.00 <br />$2,308.00 <br />$1,478.36 <br />$13,008.36 <br />Total <br />$29,042.89 <br />I artily that Pm Nebraska Department of Revenue has complied alb tee teas of the Sant of Nehmen In cletenteranp the amount shown to be Our, <br />and nu ere taxpayer hes Lied to pay tie amount due sea dement This Nabs of Stele Tax Lion le en Medan Pen and saves to apnea the priorly Of <br />Om Meath Interest in the dueled property of the tepayer. <br />sign ` ,3,,� Revenue Mont 02/21/2025 (308)632-1203 <br />here p alWaly u, Title ate race. Number <br />L1m% 41.444, Revenue Supervisor 02/21/2025 <br />Spam* <br />Tale pay <br />4404107e pea omen Susemaee 4444-1974 rov. 04013 <br />