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N <br />Good Life. Great Service. <br />C[MR?.iIWT OP=WN <br />Notice of State Tax Lien <br />202602109 <br />Nebraska Secretary of State <br />-FILED- <br />File #: 2604069993-1 <br />Date Filed: 4/6/2026 10:01 AM <br />Z0:8 9ZOZ/90/T0 9t99-SZSOD <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 lien or continuation statement. <br />PLEASE DO NOT WRITE IN THIS SPACE <br />o <br />al <br />m <br />¢' <br />0 <br />a. <br />n <br />a <br />fn <br />Nebraska ID Number <br />96959991 <br />Federal ID Number <br />NO FEIN <br />A <br />Pt <br />f„ <br />Lien Serial Number <br />12620088 <br />Uen Filed With: <br />iN Register of Deeds <br />❑ County Clerk <br />Social Security Number <br />XXX-XX-8638 <br />Spouse's Social Security Number <br />NO SPOUSE SSN <br />fD <br />n <br />Date of Uen <br />January 6, 2026 <br />Lien Type: <br />® original <br />❑ continuation ❑ corrected <br />County <br />HALL <br />0 <br />ci <br />n <br />Business Name and Location Address <br />Taxpayer Name and Mailing Address <br />FERNANDO ACOSTA VENTURA <br />822 S KIMBALL AVE <br />GRAND ISLAND NE 68801 <br />0 <br />CD <br />cr <br />a <br />cr <br />ID <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 />$1,812.00 <br />$158.41 <br />$105.64 <br />$2,076.05 <br />Total <br />$2,076.05 <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 Uen 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, Preparers Signature <br />Authorized Signature <br />Revenue Manager <br />/ Title <br />Pat/WA) Revenue Supervisor <br />Title Date <br />4-494.1974 Rev. 8-2018 Summates 4-949-1974 Rev. 8-2013 <br />01/06/2026 (402)471-5729 <br />Date Phone Number <br />01 /06/2026 <br />