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Tax Program Tax Period Date of Assessment Tax Penalty interest Costs Total Due Sales 05/01/2014 - 09/30/2014 12/01/2014 .00 .00 21.00 .00 21.00 Sales 10/01/2014 - 10/31/2014 02/02/2015 .00 .00 3.11 .00 3.11 Sales 11/01/2014 - 11/30/2014 03/02/2015 .00 .00 3.59 .00 3.59 Sales 12/01/2014 - 12/31/2014 04/01/2015 .00 .00 3.29 .00 3.29 Sales 01 /01/2015 - 01/31/2015 08/03/2015 .00 19.86 8.12 .00 27.98 Sal 02/01/2015 - 02/28/2015 09/01/2015 .00 69.77 8.77 .00 78.54 Sales 03/01/2015 - 03/31/2015 09/28/2015 .00 68.16 9.02 .00 77.18 Sales 04/01/2015 - 07/31/2015 10/13/2015 2,057.17 214.68 74.93 .00 2,346.78 Sales 08/01/2015 - 09/30/2015 01/04/2016 .00 137.21 7.66 _00 144.87 Sales 10/01/2015 - 11/30/2015 03/01/2016 716.33 141.64 16.83 .00 874.80 Sales 12/01/2015 - 02/29/2016 06/01/2016 730.04 223.04 17.38 .00 970.46 Total 4,551.60 This Notice of State Tax Lien is issued by the Nebraska Department of Revenue for unpaid taxes administered by the 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 lien for all property located in the county and rights to property owned by the taxpayer acquired before the expiration of this Iien•This lien will expire become unenforceable 10 years after the date of recording if continuation statement is recorded on or prior to the expiration the - previous - lien - otcontinuation - statement- . - - --- - -. ..... Tax or and no of - - -. ....__.._.. PLEASE DO NOT WHITE IN THIS SPACE ...- ....... _ ............. _..... _.. _ 'Flifiera11D 'NUmb6r - - -- _ 465568737 - Nebraska 10 tuber^ -- • 11841931 Lien Serial Number 11698621 Lien Filed With: Social Security Number Spouse's Social Security Number pi Register of Deeds 0 County Clan( Date of Lien July 4, 2016 Lien Type: County HALL El Original ❑ Continuation • Corrected Jul. 19. 2016 3:29PM - - NE Secretary of State - UCC --- Nebraska Department of REVENUE sign here Business Name and Location Address A lhori Signatur Notice of State Tax Lien Revenue Agent Title Revenue Senior Agent Title Taxpayer Name and Mailing Address MOTHER MAID CLEANING LLC PO BOX 5766 GRAND ISLAND NE 68802 \1a, 7381 P. 2 201604551 lIE Sec of Stei. .Tern A 6.1e - UCC En. 1111 991E777095 -7 Poe: 1 MOTHER PIAID CLEANING LLC Filed: 07/19/2016 11.09 AM I certify that the Nebraska Department of Revenue has Complied with the taws of Me State of Nebraska in determining the amount sh own to o e due. and that the taxpayer has failed to pay - punt due after demand. This Notice of State Tax Lien Is an effective hen and Serves t4 continue the prlorlry of the Si •v 'metes/ in the affected p . • .1 the taxpayer. 'repay= 's Signatur_ . i �V.., ....:a 7//j/t 0/' 402 -471 -6067 Dale Phone Number Dale y4104 -1974 Rev. 8-2013 Supersede; 4.945.1 Rev. 2-2002