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..ile Pse: Sit a ce. <br />202001932 <br />NE Sec of State - Robert B. Evnen <br />Filing Document #: 2003001547-4 Pages: 1 <br />Debtor Name: FAMOS CONSTRUCTION INC <br />Filing Date and Time: 03/27/2020 10:05 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 00 NOT WRITE IN THIS SPACE <br />Nebraska ID Number <br />9046003 <br />Federal ID Number <br />200934097 <br />Lies Serial Number <br />12048563 <br />Len Filed With: <br />© Register of Deeds ❑ County Clerk <br />Social Security Number <br />Spouses Socrat Security Number <br />Date el Len <br />February 14, 2020 <br />Lien Type. <br />El Corrected <br />County <br />11A LI <br />10 O ginal El Continuation <br />Business Name and Location Address <br />Taxpayer Name and Mailing Address <br />FAMOS CONSTRUCTION INC <br />PO BOX 1665 <br />GRAND ISLAND NE 68802 <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 />01/01,'2018 - 03131/2018 <br />05/10/2018 <br />.00 <br />17.27 <br />6.80 <br />.00 <br />24.07 <br />Withholding <br />04/01/2018 - 06130/2018 <br />08/10/2018 <br />.00 <br />19.79 <br />4.83 <br />.00 <br />24.62 <br />Withholding <br />07/01/2018 - 09.30/2018 <br />11/13/2018 <br />83.18 <br />17.27 <br />6.27 <br />.00 <br />106.72 <br />Withholding <br />01/0112019 - 03.31/2019 <br />05/10/2019 <br />355.90 <br />17.80 <br />14.12 <br />.00 <br />387.82 <br />Withholding <br />04:01/2019-06:30+2019 <br />08/12/2019 <br />432.73 <br />21.64 <br />11.73 <br />.00 <br />466.10 <br />Withholding <br />07/01/2019 - 09/30'2019 <br />11/12/2019 <br />362.82 <br />18.14 <br />5.26 <br />.00 <br />386.22 <br />Total <br />1,395.55 <br />sign <br />here <br />I certify that the Nebraska Department of Revenue has complied with the laws of the State of Nebraska in determining the amount shown to be due. <br />and yy t the taxpayer has failed to pay the amount due after demand. This Notice of State Tax Lien is an effective lien end serves to continue the priority of <br />the-. re's in Acari - Ary of the taxpayer. <br />Revenue Aunt <br />02/10/2020 402-471-5956 <br />Title Dale Phone Number <br />Revenue Senior Agent 3/2 4440Po <br />Title Dale <br />ea9e.r9ea nev. ti -20-8 Sutmmedes 49a}1974 Rev. 67:13 <br />