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To Program Tax Period . Date of Assessment Tax Penalty Interest Costs Total Due Sales 01/01/2010 - 12/31/2012 08/25/2013 .00 208.50 .00 .00 208.50 Withholding 04/01/2014 - 12/31/2014 05/22/2015 3,855.00 1,349.25 70.62 • .00 5,274.87 Withholding 10/01/20I3 - 12/31/2013 05/22/2015 .00 142.35 48.18 .00 190.53 Total 5,673.90 This Notice of State Tax Lien is issued by the Nebraska Department of Revenue for unpaid taxes administered by thorax Commissioner. Taxes, including penalties, interest, and costs, which are shown below, are due from the taxpayer and remain unpaid after demand. These taxes are a Hen for all property located In the county and rights to property owned by the taxpayer or acquired before the expiration of this lien.This lien will expire and become unenforceable 10 years after the date of recording if no continuation statement is recorded on or prior to the expiration of the previous lien or continuation statement. PLEASE DO NOT WRITE INTRIS SPACE . Nebraska ID Number 9574689 Federal ID Number 202008886 Lien Serial Number 11552316 Lien FIIed WIih: J Register of Deeds 0 County Clerk Social Security Number Spouae's Social Security Number Date of Lien June 9, 2015 Lien Type; ❑ Coded County HALL (XI Original • Conlin uallon o Jun, 18. 2015 3 :34FM NE Secretary of State — UCC Nebraska Department of REVENUE sign here Business Name and Location Address 201504106 Notice of State Tax Lien Revenue Senior Agent Title Revenue Senior Agent Title NE Sec of Sieio Date No. 1S63 F, John A Gal Tnx a er Name and Mailing Address GIGGLES INC 1409NWEBBRD GRAND ISLAND NE 68803 I certify Thal the Nebraska Department of Revenue has complied with the laws of the Stele of Nebraska In determining the amount shown to be due, and that the taxpayer has failed lo pay the amount due after demand. This Nonce of Stale Tax Uen is an effective Gen and eerves to continue the priority of the St Ie'e Interest i he affected property or the taxpayer. UCC STL 99157561a& -3 pas= GIGGLES INC Filed: 06/18l28i5 11:30 AM 06/02/2015 402- 471 -5709 Dale 4.494.1974 Rev. 8 Supersedes 4- 84.1974 Rev. 2.