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Good Life. Great Service. <br />DEPARTMENT OI REVENUE <br />Notice of State Tax Lien <br />202601548 <br />Nebraska Secretary of State <br />-FILED- <br />File #: 2603056809-6 <br />Date Filed: 3/13/2026 12:37 PM <br />C0522-8436 03/13/2026 8:18 <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 llen.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 />0 <br />r <br />¢ <br />�b <br />m <br />b <br />Fi <br />fL <br />Nebraska ID Number <br />85916242 <br />Federal ID Number A <br />Iv <br />NO FEIN <br />Lien Serial Number <br />12624012 <br />Lien Filed With: <br />4 Register of Deeds County Clerk <br />Social Security Number <br />XXX-XX-3629 <br />U. <br />Spouse's Social Security Number N <br />NO SPOUSE SSN n <br />rl <br />Date of Lien <br />February 3, 2026 <br />Lien Type: <br />Corrected <br />County h <br />HALL sv <br />n <br />LA Original Continuation <br />Business Name and Location Address <br />Taxpayer Name and Mailing Address <br />JULISSA PENA FLORES <br />928 VANDERVOORT AVE <br />GRAND ISLAND NE 68801 <br />t< <br />0 <br />i-n <br />m <br />rt <br />rt <br />c9 <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 />$382.00 <br />$19.10 <br />$24.62 <br />$425.72 <br />Total <br />$425.72 <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 0 Preparer's Signature <br />Revenue Manager 02/03/2026 (402)471-5729 <br />Title Date Phone Number <br />Revenue Supervisor 02/03/2026 <br />• <br />Authorized Signature <br />Title Date <br />4.494-1974 Rev. 8.2018 Supersedes 4-949-1974 Rev. 8-2013 <br />