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os <br />Good Life. Great Service. <br />OCM.IRM(M OF II[VLMW <br />Notice of State Tax Lien <br />202600535 <br />Nebraska Secretary of State <br />-FILED- <br />File #: 2601028853-3 <br />Date Filed: 1/29/2026 9:14 AM <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. 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 IN THIS SPACE <br />Nebraska ID Number <br />85970204 <br />Federal ID Number <br />NO FEIN <br />Lien Serial Number <br />12620530 <br />Lien Fled With: <br />Social Security Number <br />XXX-XX-485g <br />Spouse's Social Security Number <br />NO SPOUSE SSN <br />N Register of Deeds County Clerk <br />Date of Lien <br />January 8, 2026 <br />Lien Type: <br />DCorrected <br />County <br />HALL <br />/3 Original III Continuation <br />Business Name and Location Address <br />Taxpayer Name and Mailing Address <br />FERNANDO VARGAS FERNANDEZ <br />1017W14THST <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 />2024 <br />05/09/2025 <br />$881.00 <br />$44.05 <br />$51.75 <br />$976.80 <br />Total <br />$976.80 <br />I certify that the Nebraska Department of Revenue has complied with the laws of the State of Nebraska in determining the amount shown to be due, <br />and that the taxpayer has failed to pay the amount due after demand. This Notice of State Tax Lien is an effective lien and serves to continue the priority of <br />the State's interest in the affected property of the taxpayer. <br />sign <br />here r Preparer's Signature <br />Authorized Signature <br />Revenue Manager 01/08/2026 (402 )471-5729 <br />!� t �.`•.,! �' ! Title Date Phone Number <br />Revenue Supervisor 01/08/2026 <br />Title Date <br />4-494-1974 Rev. 8-2018 Supersedes 4-949-1974 Rev. 8-2013 <br />C0517-1312 01/29/2026 8:12 <br />Received by Nebraska Secretary of State <br />