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Good _Oe.Gree Ser, •T e <br />20190612 <br />NE Sec of State - Robert B. Evnen <br />Filing Documcnt #: 1910000268-7 Pages: I <br />Debtor Name: ARRIAZA &amp; PEKING PALACE LLC <br />Filing Date and Time: 10/03/2019 11:26 AM <br />Notice of State Tax Lien <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 />Vebraska ID Number <br />13185306 <br />Federal ID NJmber <br />821708348 <br />Lien Serial Number <br />11938731 <br />Lien Filed Wnh <br />[] Register o1 Deeds E County Clark <br />Social Scour ty Number <br />Spouse's Social Security Number <br />Dab of Lien <br />September 30, 2019 <br />Lien Type: <br />ElCorrected <br />County <br />HAI.I. <br />® odgeNd jCominuatlon <br />Business Name and Location Address <br />Taxpayer Name and Mailing Address <br />ARRIAZA & PEKING PALACE LLC <br />3619 BRONCO RD <br />GRAND ISLAND NE 68801 <br />Tax Program <br />Tax Period <br />Date of <br />Assessment <br />Tax <br />Penalty <br />Interest <br />Costs <br />Total Due <br />Sales <br />01/01/2019 - 01/31/2019 <br />03/05/2019 <br />.00 <br />66.19 <br />.64 <br />.00 <br />66.83 <br />Sales <br />02/01/2019 - 02/28/2019 <br />08/01/2019 <br />457.41 <br />45.74 <br />12.28 <br />20.00 <br />535.43 <br />Sales <br />03/01/2019 - 03/31//2019 <br />08/01/2019 j 614.39 <br />61.44 <br />13.88 <br />20.00 <br />709.71 <br />Withholding <br />0190112019 - 03/31/2019 <br />08/12/2019 ; 203.51 <br />30-53 <br />4.26 <br />.00 <br />238.30 <br />Total <br />1,550.27 <br />I certify that the Nebraska Department of Pevenue has complied with the laws of the Sumo( Nebraska in determining the amount shown to be due. <br />and that the taxpayer has failed to pay the amount due after demand.This Notice of State Tax Lien is an effective lien and serves to continue the priority of <br />Me Stales interest in the affecteo property of the taxpayer. <br />sign; Malin <br />here r Prepare' u Slgre <br />Authorized Signature <br />Revenue Agent <br />09/23/2019 402-471-6067 <br />Title Dale Phone Number <br />Revenue Senior Agent <br />Title Date <br />4-494.1974 Hev.. h -2G19 Supersedes 4.949-1974 Hoy . 8-25t3 <br />