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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 />Saks <br />11/01/2013 - 01/31/2014 <br />04/01/2014 <br />.00 <br />557.33 <br />211.42 <br />40.00 <br />808.75 <br />Sales <br />07/01/2014 - 07/31/2014 <br />09/02/2014 <br />.00 <br />311.96 <br />1.01 <br />.00 <br />312.97 <br />Sales _ <br />09/01 /2014 - 09/30/2014 <br />11/03/2014 <br />.00 <br />310.76 <br />28.60 <br />.00 <br />339.36 <br />Sales <br />05/01/2015 - 05/31/2015 <br />06/30/2015 <br />.00 <br />266.76 <br />100.13 <br />80.00 <br />446.89 <br />Sales <br />10/01/2014 - 04/30/2015 <br />07/01/2015 <br />.00 <br />1,499.47 <br />503.89 <br />140.00 <br />2,143.36 <br />Sales <br />06/01/2015 - 07/31/2015 <br />05/02/2016 <br />.00 <br />519.39 <br />104.80 <br />.00 <br />624.19 <br />Sales <br />08/01/2015 - 05/31/2016 <br />08/01/2016 <br />12,277.65 <br />1,870.43 <br />537.52 <br />.00 <br />14,685.60 <br />Sales <br />08/01/2016 - 08/31/2016 <br />09/30/2016 <br />1,638.55 <br />163.86 <br />15.89 <br />20.00 <br />1.838.30 <br />Sales <br />09/01/2016 - 09/30/2016 <br />11/01/2016 <br />1,753.69 <br />175.37 <br />12.68 <br />.00 <br />1,941.74 <br />Sales <br />10/01/2016 - 10/31/2016 <br />12/06/2016 <br />5331 <br />25.00 <br />.25 <br />.00 <br />78.56 <br />Total <br />23,219.72 <br />This Notice of State Tax Lien is issued by the Nebraska <br />Department of Revenue for unpaid taxes administered by the Tex <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 INTHIS SPACE <br />Nebraska ID Number <br />9572953 <br />Federal D Number <br />480844616 <br />Lien Serial Number <br />11701380 <br />Lien Flied With! <br />Social Security Number <br />XX` - XX -821z <br />Spouse's Social Security Number <br />pi Register of Deeds ■ County Clerk <br />Date of Lien <br />January 16, 2017 <br />Lien Type: <br />County <br />HALL <br />k,1 Original 0 Continuation <br />• Corrected <br />Feb. 2. 2017 3:48PM NE Secretary of State'- UCC <br />Nebraska Department of <br />REVENUE <br />sign <br />here <br />Business Name and Location Address <br />201700769 <br />Notice of State Tax Lien <br />NE Sao of Baia John A Gala . r/CC S1L <br />f <br />No. 9502 F. 2 <br />9917786381 -7 Pas: <br />SABATKA EDWARD D, <br />Filed: 02/02/2017 11:05 AM <br />Taxpayer Name and Mailing Address <br />EDWARD D. SABATKA <br />1523 S LINCOLN AVE <br />GRAND ISLAND NE 68801 <br />I certify that the Nebraska Department of Revenue has compiled with the taws of the Slate of Nebraska In delermlrteg the amount shown to be due, <br />and that t� payer has failed to oust due atter demand, This Notice of State Tax Lien is an ettective hen and serves to continue the priority of <br />the S = est In the affected r .pert . 1 the taxpayer. <br />41/./ -2/ <br />Date <br />402 - 471 -6067 <br />Revenue Agent <br />Title <br />Revenue Senior Agent <br />Tills Date <br />4-494 -1974 Rev. 8-2013 9uperaeeea 4- 949 -1974 Rev, 2-2002 <br />Phone Number <br />/ - 3/ . /7 <br />