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OB/10/2012 Fit2 14:47 FAx 402 471 4429 UCC SECRETARY OF 5TATE -��� Hall <br />�� <br />� <br />. Fi ed: <br />NOTICE OF STATE TAX LIEhI <br />This Notice of State Tax Lien is issued by the Nebraska Department of <br />Revenue for unpaid taxes pursuant to the revenue laws of the state of <br />Nebraska. Notice is hereby given that taxes including penalties and <br />lnterest, which are shown below, are du� from the taxpayer specifled <br />below and remain unpaid after demand. These taxes constitute a lien <br />in the county for real and personal properly belonging to the taxpayer <br />or hereafter acquired. _ <br />8239665 <br />20120664 <br />�breeck� d?ay:nrtvr',brri o4 <br />��E'��'�E�1�`� <br />www.F�v�.� `so.a�r, ir ati <br />��� �� ,Z ,S"'/ �Register of Deeds �County <br />s of lien Lien Typa <br />OSI06/2012 QOriginai �Continuation <br />BUSINESS NAME AND LOCATION ADDRESS <br />Category <br />Number <br />01 <br />01 <br />01 <br />01 <br />01 <br />Tax Period I Date of <br />'"" "`""" 09/07l2010 <br />07/31/2010 <br />09/01/2010 �y06/2010 <br />09/30/2010 <br />08/01 /2010 03/07/2011 <br />08l31/ZQ10 <br />10/01/2010 03/07/2011 <br />12/31/2010 <br />01 /01/2011 Q��06l2011 <br />03/31/2011 <br />Amount of Tax <br />0.00 <br />0.00 <br />5,391.58 <br />16,226.19 <br />11,167.02 <br />39-198A386 <br />�004/004 <br />►hART RND T <br />I:55 RPi <br />[]corrected Hal) <br />TAXPAYER NAME AND MAIL AD DRES S <br />Grand Island Liquor Mart and Tobacco Row L.L.C. <br />t or Other Mailing Address <br />710 N. Diers Ave. Suite L. <br />State Zip Code <br />Grand Island Ne. 68803 <br />Penalty Interest Additions Balance of <br />1,151.86 <br />507.97 <br />539.16 <br />1,822,61 <br />1,116.70 <br />21.09 900.00 <br />24.35 100.00 <br />502.97 <br />1,462.87 <br />762.05 <br />2, 072.95 <br />632.32 <br />6,433.71 <br />21,511.67 <br />13,045.77 <br />TOTAL <br />$ �43,696.42 <br />( heraby ce►tity that the Nebraska Department of Revenue has compl"�etl with the revenue laws ot tne s[a[e or rveorasKa m me ae�Crmn�auvn vr u►a <br />amount shown to be due, and the taxpayer has failed ta pay the amount due after demand. If this Notice of State Tax Lien is an extension of an <br />efFec�ive lien, it se s co�6nue the prior' the state's interest in the affected property of the taxpayer. • <br />e� ' Revenue Agent �� o? o<f— <br />402 471-6Q67 � <br />sign Preparer's Signature Title Date 7elephone Number <br />here e � � �j -Q�`- Senio� Revenue Agent rS - 9—/�. � <br />thorized ignature \ Title Date . <br />4-494-1874 Rev. 2-2�2 Supersedes 4-494-1974 Rev. 10-1995 <br />