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NEBRAS44A- <br />�-:Ud le. <br />ORR.rR.NRwR OR ROKµ< <br />NE Sec of State - Robert B. Evnen <br />Filing Document #: 2008000518-0 Pages: 1 <br />Debtor Name: C &amp; 1 EMBROIDERY INC <br />Filing Date and Time: 08/17/2020 09:15 AM <br />Notice of State Tax Lien <br />202006063 <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 WRI TE IN THIS SPACE <br />Nobtas,.a ID Number <br />11881941 <br />Fedoral ID Number <br />471540626 <br />Lion Se, al Nprrxbcr <br />12059108 <br />..ien f ted 0.110 <br />Kj Re sI r of Deeds 0 County Ciera <br />Soda! Security Number <br />Spouse's Socia: Security Nun>Ger <br />Date et Lien <br />August 10, 2020 <br />. n type: <br />Q' Odg:na: 0Gru>+tnoation 0 Corrected <br />Ccwrly <br />HALE, <br />Business Name and Location Address <br />Taxpayer Name and Mailing Address <br />C 841 EMBROIDERY INC <br />2620 S SHADY BENT) RD <br />GRAND ISLAND NF 68801 <br />"Fax Program <br />Tax Period <br />Date of <br />Assessment <br />Tax <br />Penalty <br />Interest <br />Costs Total Due 1 <br />Sales <br />07/01/2019-07/31,2019 <br />01/02.2020 <br />463.29 <br />6.86 <br />21.78 <br />20.00 511.93, <br />5 <br />Saks <br />08`01/2019-08/31:2019 <br />05'012020 <br />.00 <br />45.51 <br />12.63 <br />.00; 58.14; <br />Sales <br />09/012019 - 09/30/2019 <br />05'012020 <br />.00 <br />42.20 <br />10.64 <br />.001 52.841 <br />Saks <br />10/012019 - 10'31/2019 <br />05/01.2020 <br />.00 <br />.00 <br />10.92 <br />.001 10.92 <br />Sales <br />1110112019- 11/30/2019 <br />05/01/2020 <br />536.39 <br />53.70 <br />17.20 <br />.001i607.291 <br />Sales <br />1_2/01,2019- 12/3112019 <br />05'01/2020 <br />657.34 <br />65.73 <br />18.27 <br />.001 741.341 <br />Sales <br />01'01,2020 - 01/31/2020 <br />05101/2020 <br />136.52 <br />25.00 <br />3.71 <br />.00 164.731 <br />Saks <br />02/012020 - 0229/2020 <br />05'01.'2020 <br />441.02 <br />44.10 <br />8.63 <br />.001 493.75 <br />Sales <br />03/01'2020 - 03/312020 <br />05/01/2020 <br />.00 <br />25.00 <br />.00 <br />.001 25.00 <br />Total' i '665-94 <br />sign <br />here <br />!certify that the Nebraska Department al Revenue has complied 01h the laws b? the State of Nebraska in eeterraadng the a *w'.I 5110.0n to be dee, <br />and that the taxpaye' has faded to pay 01e amount Poe after demand. Ties Notice at State Tax Lien is. an e0001Y0 Inc and serves to continue lee priority al <br />he 5,t0le`s tr.tems'. the atieoted oreperty of the taxpayer. <br />1. r. s <br />Revenue Agent <br />08/03/2020 402-471-5956 <br />"lige Date Phone Number <br />Revenue Senior Agent <br />Date <br />MAN. ,:974 PAN !.20'8 Saewile kis 4.94554510 44, u.sk)13 <br />