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�1 J Vlar, 21. 2017 2: 07PM NE Secretary of State - UCC 2 1701747 1 6/ NE Sae ei 54•4a John fl 5.1 - UCC STL l u . 99]77880 2-5 Pes: 1 ORAND S AUTOMOTIVE d: 031'i120170B 43 C AM . Nebraska 0epartmentof REVENUE Notice of State Tax Lien This Notice of State Tax Lien is issued by the Nebraska PLEASE DO NOT WRITE IN THIS S-ACE Department of Revenue for unpaid taxes administered by the Tax Commissioner. Taxes, including penalties, interest, and costs, which are shown below, are due from the taxpayer and remain unpaidafter demand,These taxes are a lien 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. Nebraska ID Number Federal ID Number 4014065 470636508 Lien Serial Number Lien Filed with: Social Security Number SpOuse`3 Social Security Number . 11782751 ®Register of Deeds 0 County Cleric Date of Liar. Lien Type: County January 24,2017 ®Original 0Continuation ❑corrected }TALL I Business Name and Location Address Taxpayer Name and Mailing Address I GRAND ISLAND AUTOMOTIVE INC GRAND ISLAND KART&CYCLE 3630 SOUTH LOCUST . GRAND ISLAND NE 68801 Tax Program Tax Period Date of Tax Penalty Interest Costs Total Due Assessment _ Sales 11/01/2014-06/30/2015 09/01/2015 .00 .00 32.88 .00 32.88 Sales 10/01/2015- 12/31/2015 03/01/2016 .00 .00 4.66 .00 4.66 Sales 01/01/2016-03/31/2016 05/02/2016 .00 30.80 L39 _00 32.19 Sales 04/01/2016.07/31/2016 11/14/2016 3,840.00 757.68 64.07 .00 4,661.75 Waste Reduction 07/01/2014.06/30/2015 02/19/2016 .00 5.00 .46' .00 526 Withholding 04/01/2015-06/30/2015 08/28/2015 .00 60.62 1.78 .00 62.40 Withholding 07/01/2015-09/30/2015 11/30/2015 .00 55.72 1._6 .00 57.28 Withholding 10/01/2015- 12/31/2015 02/11/2016 .00 78.08 .64 .00 78.72 Withholding 01/01/2016-03/31/2016 05/10/2016 934.42 66.13 25.t8 .00 1,025.83 Withholding 04/01/2016--06/30/2016 11/14/2016 _ 1,515.00, 303.00 22,94 .00 1,840.04 Total 7,801.01 I certify that the Nebraska Department 01 Revenue Des complied with the laws of the State of Nebraska in delermining the amount shown to be due, and that the taxpayer has failed to tray nt due aher demand..This Notice of Slate Tax Lien is an attentive lien and serVes to continue the priority 01 the Ste ' areal in me affected pro.: t 0 taxpayer. sign /9e- �.,� Revenue Agent -/ -ar'i7 402-411-6067 here Prepay Si_nature Title Date Phone Number ,,/!� �.1A Revenue Senior Agent 347-9 Authorized Signature Title Dale 4-191.1974 Rey.8-2019 supersedes 4-949-1974 Rea 2-2002