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N1. <br />rrnott :e. C'ret :qtr'.,;: <br />.0.1141.4 <br />NE Sec of State - Robert B. Evnen <br />Filing Document #: 2010001309-6 Pages: 1 <br />Debtor Name: NICK TERJAK <br />Filing Date and Time: 10/28/2020 10:21 AM <br />Notice of State Tax Lien <br />202008364 <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.Thla lien will expire and <br />become unenforceable 10 years after the date of recording it 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 INTHIS SPACE <br />Nob, kit t0 Number <br />13462881 <br />Fal 10 Aumbel <br />Llen Senel Number <br />12062440 <br />Tem toed w<r, <br />;KRatonoroIDaaJa 0COW'S Clerk <br />Sortel Socvdty Number <br />XXX -XX -5974 <br />Spoutsets Socia: 500,00 Mangler <br />tMb alt ion <br />October 5, 2020 <br />Lien Type: <br />LX1 pnptnat uconteutdtcn ❑cot ec a <br />County <br />HALL <br />Business Name and Location Address <br />axpayer Name and tutailing Address <br />NICK TERJAK <br />IMP SERVICES <br />505 N CUSTER <br />GRAND ISLAND NE 68803 <br />Tax Progritn <br />Tax Period <br />bite of <br />Assessment <br />Tax <br />Penalty <br />Interest <br />Costs <br />Total Due <br />Withholding <br />10/012019- 12/312019 <br />0710412020 <br />300.00 <br />90.00 <br />10.18 <br />.00 <br />400.18 <br />Withholding <br />01/0'2020-03/3112020 <br />07/04/2020 <br />300.00 <br />45,00 <br />6.48 <br />.00 <br />351.48 <br />Total <br />751.66 <br />sign <br />here <br />I * bty that the Nebraska Oep0•lmeot et Revenue pas comidie0 oath the taws 04 the Sate al Nebnike n 00termwa05 the amount shown to to dot, <br />and Tat tho latidoyor has 40004 to pay the amount doe akar <fatnarre. This Notice at State Lea Lien is en seedlw Oen eat serves to tante,. the priors:, at <br />11:e ante's MAfree1 in ale fleeted moped .. y: taxpayer, <br />Authorized <br />Revenue Agent 09/28/2020 <br />two <br />Revenue Senior Agent <br />Tina <br />402.471-6067 <br />Oxto <br />/0/f Zo <br />Dale <br />4414,971 Res aeare 54m0n +wr a,gabtan no„ 940.3 <br />