Laserfiche WebLink
Tax Program <br />Tax Period <br />Date of <br />Assessment <br />Tax <br />Penalty <br />Interest <br />Costs <br />Total Due <br />Withholding <br />04/01/2017 - 06/30/2017 <br />08/10/2017 <br />8,860.89 <br />443.04 <br />38 -60 <br />.00 <br />9,342.53 <br />Total <br />9,342.53 <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 Iien.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 />12677795 <br />Federal ID Number <br />813801575 <br />Lien Serial Number <br />11794508 <br />Lien Flied Wlth: <br />Social Security Number <br />Spouse's Social Security Number <br />C7 Register 01 Deeds ❑ County Cleric <br />Date of Lien <br />September 22, 2017 <br />Lien Type: <br />nCorrected <br />County <br />HALL <br />RI Original 0Continuation <br />o� <br />sign <br />here <br />S 27. 21117 3 :46FM NE Secretary of State — UCC <br />Nebraska Deparrmenrat <br />REVENUE <br />Authorized Signature <br />20170653E <br />Notice of State Tax Lien <br />Nh. 2089 F. <br />- ❑CC sT. <br />99177988897 Pea; 1 <br />GRAND I5LAND PARK PLAGE CARE 8 <br />Filed; 05/27/2017 09";42 AN <br />E Sec of S4ete John A Gale <br />Business Name and Location Address Taxpayer Name and McII Address <br />GRAND ISLAND PARK PLACE CARE & REHABILIT <br />610 NORTH DARR <br />GRAND ISLAND NE 68803 <br />1 certify thal the Nebraska Oeparlment of Revenue has complied with the laws of the State of Nebraska in determining the amount shown to be due, <br />and that the taxpayer has sailed lo pay the amount due after demand. This Notice of State Tax Lien Is an effective lien and serves to continue the priority of <br />t h e State's interest In the affected prop .rty . f the taxpayer. <br />Revenue Senior Agent 09/22/2017 402 -471 -5727 <br />Title Date Prone Number <br />Revenue Senior Agent 9-.4 r <br />Title Date <br />4 -494 -1974 Rev. 8-2013 Supetaeaea 4-949 -1974 Rev.2 -2002 <br />X11 ,1 <br />