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Good Life Great Service <br />CFNGlMiM N ■IVINW <br />Notice of State Tax Lien <br />202601087 <br />Nebraska Secretary of State <br />-FILED- <br />File #: 2602045108-9 <br />Date Filed: 2/25/2026 9:23 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 ail 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 />92289312 <br />Federal ID Number <br />NO FEIN <br />Lien Serial Number <br />12623513 <br />Lien Red With: <br />Social Security Number <br />)()()(-XX-4322 <br />Spouse's Social Security Number <br />NO SPOUSE SSN <br />Register of Deeds • County Clerk <br />Date of Lien <br />January 29, 2026 <br />Lien Type: <br />County <br />HALL <br />E.4 Original II Continuation <br />• Corrected <br />Business Name and Location Address <br />Taxpayer Name and Mailing Address <br />PEDRO M ORTIZ <br />1115 W 9TH 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 />2023 <br />05/07/2024 <br />$1,567.00 <br />$78.35 <br />$191.13 <br />$1,836.48 <br />Total <br />$1,836.48 <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, Preparer's Signature <br />Authorized Signature <br />Aunaki <br />Revenue Manager 01/29/2026 (402)471-5729 <br />Title Date Phone Number <br />Revenue Supervisor 01/29/2026 <br />Title Date <br />4-494-1974 Rev. 8-2018 Supersedes 4-949-1974 Rev. 8-2013 <br />CO520-4690 02/25/2026 8:09 <br />Received by Nebraska Secretary of State <br />