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201905677. <br />NE Sec of state -Robert B. Evnen <br />Filing Document #: 1909000638-6 Pages: 1 <br />Debtor Name: TOMS DELIVERY SERVICE INC <br />Filing Date and Time. 09/13/2019 10.29 AM <br />W <br />N EBPA. <br />-14.: rv,, Notice of State Tax Lien <br />This Notice of State Tax Lien is issued by the Nebraska <br />PLEASE DO NOT WRITE IN THIS SPACE <br />Department of Revenue for unpaid taxes administered by the Tax <br />Tax <br />Commissioner. Taxes, including penalties, interest, and costs, <br />Interest Costs <br />which are shown below, are due from the taxpayer and remain <br />Withholding <br />unpaid after demand.These taxes area lien for all property located <br />02/11 !2019 <br />in the county and rights to property owned by the taxpayer or <br />51.53 <br />acquired before the expiration of this lien.This lien will expire and <br />1,085.31 <br />become unenforceable 10 years after the date of recording if no <br />01/01/2019 - 03/31 /2019 <br />continuation statement is recorded on or prior to the expiration of <br />2,221.82 <br />the previous lien or continuation statement. <br />34.10 .00 <br />Nebraska ID Number <br />Federal ID Number <br />04/01/2019 - 0(!/30!2019 <br />202576303 <br />_9616950 <br />Lien Serial Number <br />Lien Filed With: <br />Social Security Number <br />Spouse's Social Security Number <br />11935502 <br />Q Register of Deeds Ej County Clerk <br />Date of Lien <br />Lien Type: <br />County <br />August 20, 2019 <br />0 Origira Continuation Corrected <br />HALL <br />I Business Name and Location Address taxpayer Name ane loaning Roaress <br />TOMS DELIVERY SERVICE INC <br />2407 W 4.111 S'T <br />GRAND ISLAND NI 68803 <br />Tax Program <br />Tax Period <br />Date of <br />Assessment <br />Tax <br />Penalty <br />Interest Costs <br />Total Due <br />Withholding <br />10!01+'2018 - 12%31;2018 <br />02/11 !2019 <br />17005.60 <br />51.53 <br />28.18 .00 <br />1,085.31 <br />Withholding <br />01/01/2019 - 03/31 /2019 <br />05110!2019 <br />2,221.82 <br />1 1 1.09 <br />34.10 .00 <br />2.367.01 <br />Withholding <br />04/01/2019 - 0(!/30!2019 <br />081212019 <br />33.216.85 <br />160.84 <br />8.81 .00 <br />3,386.50 <br />Total <br />6,838.82 <br />-94-1974 R@ . P.-MlA Supe,iie cs 4949.1974 Rev. 8-2013 <br />I certify that the Nebraska Department of Revenue has <br />complied with the laws of the Stale of Nebraska <br />in determining the amount shown to be due. <br />and that the taxpayer has `ailed to pay the amount due after demand. This Notice of State Tax Lien is an effective lien and serves to conbn„e the ptiority of <br />the States interest in the affected property of the taxpayer. <br />sign <br />fr.5t_i k­jil" <br />Revenue Agent <br />08!13/2019 402-471-5723 <br />here <br />f'reparer's "at re <br />Tale <br />Date Phon Number <br />z�A j <br />Revenue Senior A6�4gent <br />1-61-Y9 <br />Authorized Signature <br />Till. <br />Date <br />-94-1974 R@ . P.-MlA Supe,iie cs 4949.1974 Rev. 8-2013 <br />