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Tax Program <br />Tax Period <br />Date of <br />Assessment <br />Tax <br />Penalty <br />Interest <br />Costs <br />Total Due <br />Sales <br />11/01/2015 - 11/30/2015 <br />02/01/2016 <br />853.43 <br />85.34 <br />9.67 <br />.00 <br />948.44 <br />Withholding <br />10/01/2015 - 12/31/2015 <br />01/15/2016 <br />.00 <br />•00 <br />.00 <br />20.00 <br />20.00 <br />Total <br />968.44 <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 coats, <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 />Nebraska ID Number <br />12031755 <br />Federal ID Number <br />473885908 <br />Lien aerial Number <br />11697842 <br />Llen Filed With: <br />Social Security Number <br />Spouse's Social Security Number <br />El Register of Deeds ❑ County Clerk <br />Date of Lien <br />May 6, 2016 <br />Lien Type: <br />Canty <br />HALL <br />M Original E Continuation <br />U Corrected <br />Jun.23. 2016 3:15PM NE Secretary of State. — UCC <br />Nebraska Depenmenr of <br />REVENUE <br />sign <br />here <br />Business Name and Location Address <br />Authorized Signature <br />2016103883 <br />Notice of State Tax Lien <br />Revenue Agent <br />Title <br />Revenue Senior Agent <br />Title <br />ME we of %In4•-1ohn A• Gale- - UCG_STL <br />H 111 <br />9916775847 -0 pas: 1 <br />ORNELFIS1 INC. <br />Filed; 6/23/2018 1 ®:6S AM <br />Vo. 7110 P. 2 <br />Taxpayer Name and Mailing Address <br />ORNELAS, INC. <br />2418NWEBBRD STEA <br />GRAND ISLAND NE 68803 <br />I certify that the Nebraska Department of Revenue has oomplied 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 am .. us after demand. This Notice of State Tax Lien is an effective lien and serves to continue the priority of <br />me Sl=1l nterest in the affected property epayer. <br />/ / / Date <br />402 -471 -6067 <br />Phone Number <br />4.a /. /G <br />Date <br />4 - 454.1571 Rev. 54013 Supersedes 4- 949.1975 Rev 2.2002 <br />