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Good Life. Great Service. <br />owrrmara IVI I <br />Notice of State Tax Lien <br />202002035 <br />Nebraska Secretary of State <br />-FILED- <br />File #: 2604068141-8 <br />Date Filed: 4/2/2026 8:18 AM <br />CO525-3133 04/02/2026 8:06 <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 Ilen 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 Ilen or continuation statement. <br />PLEASE DO NOT WRITE INTHIS SPACE <br />a <br />c <br />c <br />o <br />0 <br />m <br />o <br />1-1 <br />a <br />to <br />Nebraska ID Number <br />92387691 <br />Federal ID Number 7r <br />a <br />NO FEIN V <br />Uen Serial Number <br />12620136 <br />Lien Filed With: <br />® Register of Deeds ❑ County Clerk <br />Social Security Number <br />XXX-XX-2485 <br />Spouse's Social Security Number (D <br />NO SPOUSE SSN n <br />Date of Lien <br />January 6, 2026 <br />Lien Type: <br />RI Original ❑ Continuation ■ Corrected <br />County N <br />r1 <br />HALL a <br />I-1 <br />Business Name and Location Address <br />Taxpayer Name and Mailing Address <br />CARLOS A BUSTO GONZALEZ <br />APT 1 <br />209 MAKAYLA AVE <br />GRAND ISLAND NE 68803 <br />0 <br />rt, <br />rt <br />rt <br />m <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 />$1,049.00 <br />$52.45 <br />$61.16 <br />$1,162.61 <br />Total <br />$1,162.61 <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 alter demand. This Notice of State Tax Lien is an effective lien and serves 10 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 />Revenue Manager <br />(J24&)t) <br />Tlt►e <br />Revenue Supervisor <br />01/06/2026 (402)471-5729 <br />Date Phone Number <br />01/06/2026 <br />Title Date <br />4-494-1974 Rev. 8-2019 Supersedes 4-949-1974 Rev. &2013 <br />