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Jan. 31. 2019 2:48PM NE Secretary of State <br />A.rrrcrr- <br />6rxxl i,i par V.Gnroc:o <br />11,0*741 d M'MY <br />201900655 <br />No. 1721 <br />NE Sea of Sisk - Roberta. Evuen <br />Doeumentli; 1901002071-9 Pages; 1 <br />bawlsThuaa: RAN A' DACE <br />Piling Date rad Time: 01/3112019 12:12 PM <br />Notice of State Tax Lien <br />This Notice of State Tax Lien Is issued by the Nebraska <br />Department of Revenue for unpaid fates administered by the Tax <br />Commissioner. Taxes, including penalties, interest, and costs, <br />which aro shown below, are due from the taxpayer and remain <br />unpaid after dernand.These taxes ere a Nen for all property located <br />in the county and rights to property owned by the taxpayer or <br />acquired before the expiration of tails Ilen.Thls Hort wilt expire end <br />become unenforceable 10 years atter the date of recording If no <br />cOntlnUatlan 6 tatemant is recorded on or prior to lire expiration of <br />the previous lien or continuation statement. <br />PLEASE DO NOT WHITE IN THIS SPACE <br />NfltXaYW ID d 1 Ar <br />8694500 <br />Lien sedal rilmbee <br />11921336 <br />Federal 10 Number <br />Llan Piled Yen: <br />El *viols(' 01 Deed e El Gouts y 1erk <br />Social so; wdy Nuttier <br />XXX -NX -4443 <br />Spousea Soeoi Saw*/ Number <br />Dam a Lien Lien Type: <br />January 17, 2019 ® °rebel ❑ coralasaxe, ❑Coaectelt HALL <br />au3Iness Name and Location Address <br />Taxpayer Natne and Melting Address <br />f2AKOY RACK <br />R L RACK 1-1ORS1Si10bfNG & FORGE <br />112 CAMPBELL <br />DONIPHAN NE 68832 <br />Tax Program <br />Tax Period <br />bate of <br />Assessment <br />far <br />Penally ' <br />Interest <br />Costs <br />Total Due <br />Sales <br />01/01/2015 - 12131/2015 <br />08/09/2016 <br />.01 <br />124-50 <br />.64 <br />.00 <br />125.15 <br />Sales <br />01/01/2016 - 12/31/2016 <br />08/Z2/2017 <br />300,00 <br />60.00 <br />18.17 <br />.00 <br />378.17 <br />Sales <br />01/0112017- 12/3i/2017 <br />08/07/2018 <br />375.00 <br />75.00 <br />1150 <br />.00461.50 <br />~ <br />Total <br />964.82 <br />I cofldy run Vie Nebraska Deparenant of Feranaa has 0prrl01;ed YAII Llle I er Ru SW., or Nebreepe In den, the amour kr,o.vn b be dUe, <br />and Reel ea mower NM k ted to pay Re anlorael taro eller demand. This Mellon o! Slate Yaz Llan In en effective ton and n41,61410 004.11.1e Noe pia* dl <br />the Bares. renes. In Ire altered peppily 0 aha Iexpeyof, <br />sign vieg,c ,, -a <br />here �r�rs .tea <br />� JvL_. . <br />Au hoeuz l Sienakee <br />v 1 p, , y l 01/0312,019 402-471-5717 <br />THO Dap Phone Nurabur <br />Revenue Senior Agent <br />Deo <br />.45.1407% limn-70M Otomegat 4-9u11.10. taol7 <br />