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Tax <br />Category <br />Tax Period <br />Date of <br />Amount of Tax <br />Penalty <br />Interest <br />Additions <br />Balance of <br />Number <br />Assessment <br />Assessment Due <br />Sep. 5. 2013 3:44PM NE Secretary of State — UCC <br />Lien Serial Number <br />11 3905 <br />Dale of Lie <br />Business Name <br />Street Address <br />City <br />01 <br />21 <br />21 <br />08/23/2013 <br />BUSINESS NAME AND LOCATION ADDRESS <br />07101 /201 05/12/2013 <br />07/31 /2012 <br />Sign rape is Signature <br />here �? <br />ulhorized Signature <br />201307282 <br />,7MO•eOprol 01 <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 />interest, which are shown below, are due from the taxpayer specified <br />below and remain unpaid after demand. These taxes constitute a lien <br />in the county for real and personal property belonging to the taxpayer <br />or hereafter acquired. <br />Nebraska Identification Number <br />10503927 <br />REVENUE, NOTICE OF STATE TAX LIEN <br />wwti.•v10wnvv.11 <br />Lien Filed With <br />Register of Deeds County Clerk <br />State Zip Code <br />Lien Type <br />Al Original DContinuation DCorrected <br />890.00 <br />Federal Identification Number <br />Name <br />City <br />i Revenue Agent <br />NEW PEKING PALACE INC <br />Street or Other Mailing Address <br />2715 STEWART DR <br />GRAND ISLAND <br />04/01 /2012 <br />06/30/2012 <br />07/01/2012 <br />09/30/2012 <br />11/09/2012 <br />05/12/2013 <br />162.75 <br />83.00 <br />24.41 <br />33.30 <br />6.55 <br />2.29 <br />TOTAL <br />178.00 <br />26- 4764122 <br />PLEASE DO NOT WRITE IN THIS SPACE <br />Social Security Number <br />Title Date <br />County <br />HALL <br />TAXPAYER NAME AND MAILING ADDRESS <br />33.41 <br />Or <br />No. 0757 P. 3/3 <br />State <br />NE. <br />es Sao f <br />\ 99 072214/-7 <br />FilPE <br />d: 09/05/2413 <br />INC <br />oa:®4 <br />PM <br />Spouse's Social Security Number <br />Zip Code <br />68801 <br />1,101.41 <br />193.71 <br />118.59 <br />$ 1,413.71 <br />I hereby certify that the Nebraska Department of Revenue has complied with the revenue laws of the State of Nebraska in the determination of the <br />amount shown to be due, and the taxpayer has failed lo pay the amount due after demand. If this Notice of State Tax Lien Is an extension of an <br />effective lien, it se continue the prio f the state's Interest In the affected property of the taxpayer. <br />402 471-6067 <br />Telephone Number <br />r. <br />Revenue Senior Agent -��D— 13 <br />Title Dale - <br />4-04 -1974 Rev. 2-2002 Supersedes 4-494 -1974 Rev. 10-105 <br />