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Tax Program <br />Tax Period <br />Date of <br />Assessment <br />Tax <br />Penalty <br />Interest <br />Costs <br />Total but <br />Litter Fee <br />07/01/2014 - 06/30/2015 <br />05/21/2016 <br />47.75 <br />29.78 <br />1.07 <br />.00 <br />78.60 <br />Sales <br />04/01/2015 - 04/30/2015 <br />06/01/2015 <br />.00 <br />.00 <br />.15 <br />.00 <br />.15 <br />Sales <br />05/01/2015 - 05/31/2015 <br />09/01/2015 <br />.00 <br />.00 <br />6.34 <br />.00 <br />6.34 <br />Sales <br />06/01/2015 - 06/30/2015 <br />09/01/2015 <br />.00 <br />.00 <br />2.67 <br />.00 <br />2.67 <br />Sales <br />07/01/2015 - 07/31/2015 <br />12/01/2015 <br />.00 <br />139.99 <br />11.83 <br />.00 <br />151.82 <br />Sales <br />08/01/2015 - 12/31/2015 <br />04/27/2016 <br />7,204.73 <br />720.48 <br />113.29 <br />.00 <br />8,038.50 <br />Sales <br />01/01/2016 - 02/29/2016 <br />05/21/2016 <br />4,280.00 <br />856.00 <br />28.64 <br />.00 <br />5,164.64 <br />Withholding <br />01/01/2016 - 03/31/2016 <br />05/10/2016 <br />364.53 <br />18.23 <br />.78 <br />.00 <br />383.54 <br />Total <br />13,826.26 <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 lien.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 />11872314 <br />Federal 0 Number <br />471396107 <br />Lien Serial Number <br />11698113 <br />Lien Flied With: <br />Social Security Number <br />Spouse's Social Security Number <br />ri Register of Deeds ❑ County Clerk <br />Date of Lien <br />May 26, 2016 <br />Lien Type: <br />❑ Corrected <br />County <br />HALL <br />Original ❑ Continuation <br />Jul, 6. 2816 4:04FM NE Secretary of State - UCC <br />201604226 <br />Nebraska Deportment of <br />REVENUE <br />sign <br />here Prap- <br />Business Name and Location Address <br />I certify that the Nebraska Oepe <br />and that the taxpayer has fatted <br />the StaA interest in The affec <br />rs Signature <br />Authorized Signature <br />Notice of State Tax Lien <br />Revenue Agent <br />Tile <br />Revenue Senior Agent <br />Title <br />E <br />9916776492 -8 Pas <br />(OWING <br />Filed: 07/0612016 12:01 PM <br />Date <br />Taxpayer Name and Mailing Address <br />ADAME INC <br />2261 N WEBB ROAD <br />GRAND ISLAND NE 68803 <br />No. 7268 a o F-. 2/458 <br />t of Revenue has complied with the taws of the State of Nebraska in determining the amount shown to be due, <br />amount due after demand. This Notice of Slate Tax Lien is an effective lien and serves to continue the priority of <br />rty OI the taxpayer, <br />6/ ? /'a' /!0 402-471-6067 <br />Phone Number <br />�- <br />3o-i6, <br />Oate <br />4 -484 -1971 Rev, 5-2013 Svperspdse 4rg49.1971 Rev. 22002 <br />