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Good Life. Great Service. <br />OIPARTNINT CM RtVUNR* <br />Notice of State Tax Lien <br />202601360 <br />Nebraska Secretary of State <br />-FILED- <br />File #: 2603051939-6 <br />Date Filed: 3/6/2026 10:59 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 />49154427 <br />Federal ID Number <br />NO FEIN <br />Lien Serial Number <br />12625046 <br />Lien Fled With: <br />Ki Register of Deeds <br />County Clerk <br />Social Security Number <br />XXX-XX-8893 <br />Spouse's Social Security Number <br />NO SPOUSE SSN <br />Date of Lien <br />February 6, 2026 <br />Lien Type: <br />0Corrected <br />County <br />HALL <br />l Original <br />II Continuation <br />e and Location Address <br />Taxpayer Name and Mailing Address <br />DAVID F ORTIZ <br />718 N LINCOLN AVE <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 />2017 <br />12/02/2024 <br />$590.06 <br />$323.25 <br />$436.56 <br />$1,349.87 <br />Individual <br />2018 <br />12/02/2024 <br />$738.00 <br />$184.50 <br />$246.49 <br />$1,168.99 <br />Total <br />$2,518.86 <br />1 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 States interest in the affected property of the taxpayer. <br />sign <br />here Preparer's Signature <br />Authorized Signature <br />Revenue Manager 02/06/2026 (402)471-5729 <br />Title Date Phone Number <br />Revenue Supervisor 02/06/2026 <br />Title Date <br />4-494-1974 Rev. 8-2018 Supersedes 4-949-1974 Rev. 8-2013 <br />ZZ:8 9ZOZ/90/E0 0968-TZSO3 <br />Received by Nebraska Secretary of State <br />