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sign <br />here % Preparer's Signature <br />Authorized Signature <br />yEB14A-S44-A- <br />Good Life Great Service. <br />OIMNTNINT OP NEVENYE <br />Notice of State Tax Lien <br />2026011 59 <br />Nebraska Secretary of State <br />-FILED- <br />File #: 2602046913-1 <br />Date Filed: 2/27/2026 10:32 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 Iien.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 Hen or continuation statement. <br />PLEASE DO NOT WRITE IN THIS SPACE <br />Nebraska ID Number <br />92338720 <br />Federal ID Number <br />NO FEIN <br />Lien Serial Number <br />12624871 <br />Lien Filed With: <br />Social Security Number <br />)00(-XX-2656 <br />Spouse's Social Security Number <br />NO SPOUSE SSN <br />pi Register of Deeds III County Clerk <br />Date of Lien <br />February 5, 2026 <br />Lien Type: <br />County <br />HALL <br />li Original • Continuation <br />111 Corrected <br />usiness Name and Location Address <br />Taxpayer Name and Mailing Address <br />ELIZABETH GUERRERO JAQUEZ <br />4365 RODNEY CIRCLE <br />GRAND ISLAND NE 68803 <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 />$90.29 <br />$105.08 <br />$92.42 <br />$287.79 <br />Individual <br />2024 <br />05/09/2025 <br />$730.00 <br />$63.48 <br />$47.36 <br />$840.84 <br />Total <br />$1,128.63 <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 />luAdi r Revenue Manager 02/05/2026 (402)471-5729 <br />Title Date Phone Number <br />Revenue Supervisor 02/05/2026 <br />Title Date <br />4-494-1974 Rev. 8.2018 Supersedes 4-949-1974 Rev. 8-2013 <br />60:8 9Z03/L3/Z0 bS£8-0ZS03 <br />Received by Nebraska Secretary of State <br />