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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 />10/01/2016 - 12/31/2016 <br />05/07/2017 <br />21930 <br />88,50 <br />333 <br />.00 <br />311.53 <br />Sales . <br />07/01/2016 - 09/30/2016 <br />05/07/2017 <br />208.44 <br />88.50 <br />5.12 <br />.00 <br />302.06 <br />Sales <br />04/01/2016 - 06/30/2016 <br />05/07/2017 <br />224.07 <br />88.50 <br />7.21 <br />.00 <br />319.78 <br />Withholding <br />07/01/2016 - 09/30/2016 <br />05/07/2017 <br />275.00 <br />96.25 <br />5.76 <br />.00 <br />377.01 <br />Withholding <br />04/01/2016 - 06/30/2016 <br />05/07/2017 <br />275.00 <br />96.25 <br />7.84 <br />.00 <br />379.09 <br />Withholding <br />10/01/2016 - 12/31/2016 <br />05/07/20I7 <br />275.00 <br />55.00 <br />3.68 <br />.00 <br />333.68 <br />Withholding _ <br />01/01/2016 - 03/31/2016 <br />05/07/2017 <br />275.00 <br />96.25 <br />9.92 <br />.00 <br />381.17 <br />Total <br />2,404.32 <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 10 Number <br />11981768 <br />Federal ID Number <br />464427701 <br />Lien Serial Number <br />11792040 <br />Lien Filed With: <br />Social Security Number <br />XXX-XX-4921 <br />Spouse's Social Security Number <br />® Register of Deeds • County Clerk <br />Date of Lien <br />August 15, 2017 <br />Lien Type: <br />County <br />HALL <br />EN Original ❑ Continuation <br />1 Corrected <br />Aug, 25. 2017 3:07FM NE . _ cretary of State - UCC <br />O <br />Nebraska Department of <br />REVENUE <br />Business Name and Location Address Taxpayer Name and Mailing Address <br />sign <br />here <br />I certify Thal the Nebraska Department <br />and Mai the taxpayer has failed to pay <br />the Sl =mil areal in the affected pro <br />Notice of State Tax Lien <br />BRITNY K. ARTOLA <br />2422 WEST 18Th <br />GRAND ISLAND NE 68803 <br />201147057269 <br />NV 5.c a1 44a+e John R Oar. . UCC SY1. <br />991779 -7 <br />Pox: 1 <br />Filed: 09/26/2017 09 :42 PM <br />evenue has complied with the laws of the State of Nebraska In determining the amount ammo 10 be due, <br />unt clue atter demand. This Notice of State Tax Lien Is an elfecGve Tien and aervea to continue the priority of <br />me taxpayer, <br />Revenue Agent 08/21/2017 402 -471 -6067 <br />Title Date Phone Number <br />Revenue Senior Agent 3 I f <br />Authorized Signature Title Date <br />4-e94-101e Rev, 8-2013 Sup ersedes 4-949 -1974 Rev,2 -2o02 <br />