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r <br />NBW SKA <br />Sent'+ Ife. (,rent Se,vice <br />20200044. <br />NF Sec of State - Robert B. Evnen <br />Filing Document #: 2001001033-8 Pages: 1 <br />Debtor Name: VITAL SIGNS INC <br />Filing Date and Time: 01/21/2020 10:37 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 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 />8115109 <br />Federal 10 Number <br />470813036 <br />Lien Serial Number <br />11943177 <br />Lion Filed With. <br />Social Security Number <br />Spouses Social Security Number <br />® Register of Deeds II County Clerk <br />Date of Lien <br />November 14, 2019 <br />Lien Type: <br />.00 <br />75.00 <br />County <br />HALL <br />K1 ongrrtal • Contindation <br />• Corrected <br />Business Name and Location Address <br />Taxpayer Name and Mailing Address <br />VITAL SIGNS INC <br />2218 WEST 2ND ST <br />GRAND ISLAND NE 68803 <br />Tax Program <br />Tax Period <br />Date of <br />Assessment <br />Tax <br />Penalty <br />Interest <br />Costs <br />Total Due <br />Withholding <br />10'01/2016 - 06'.02017 <br />11/20/2017 <br />.00 <br />75.00 <br />.00 <br />.00 <br />75.00 <br />Withholding. <br />07101/2017 - 06'30/2019 <br />10J28/2019 <br />700.00 <br />270.00 <br />32.56 <br />.00 <br />1,002.56 <br />Total <br />1,077.56 <br />sign <br />here F'reparp <br />Authonzeo <br />I certify that the Nebraska Department of Revenue has complied with the laws of the Slam of Nebraska it determining the amour shown to oe due. <br />and That the taxpayer has failed to pay lne amount due atter demand. Ibis Notice of State lav Lien is an elect,* hen and Serves to cobbnue the homey of <br />the S 4 e's interest it the affected pmperly of Me taxpayer. <br />9 <br />Revenue Senior Agent <br />11/0712019 402-471-5709 <br />Title <br />Revenue Senior Agent <br />Date <br />Phone Number <br />its l ago Zv <br />Title Date <br />4-494-1971 fun. 9-2016 5upersedes 4949.1374 Fay. 9.2013 <br />