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r Goon Lire. S -eat Se,mce, 1.11110•111,011111111f ••••••IVII 202101508 NE Sec of State - Robert B. Eynon Filing Document #: 2102000970-1 Pages: 1 Debtor Name: S -FIVE PROMOTIONS INC Filing Date and Time: 02/23/2021 09:19 AM Notice of State Tax Lien This Notice of State Tax Lien is issued by the Nebraska Department of Revenue for unpaid taxes administered by the Tax Commissioner. Taxes, including penalties, interest, and costs, which are shown below, are due from the taxpayer and remain unpaid after demand.These taxes are a lien for all property located in the county and rights to property owned by the taxpayer or acquired before the expiration of this lien.This lien will expire and become unenforceable 10 years after the date of recording if no continuation statement is recorded on or prior to the expiration of the previous lien or continuation statement. PLEASE DO NOT WRITE INDUS SPACE Nebraska ID Number 13549480 Federal I0 Number 204787022 Lien Serial Number 12168645 Lien Filed With: Social Security Number Spouses Social Security Number ® Register of Deeds (II County Clerk Date of Lien February 11, 2021 Lien Type: ❑Comced County HALL © Original ■ Continuation Business Name and Location Address Taxpayer Name and Mailing Address S -FIVE PROMOTIONS INC CBD AMERICAN SHAMAN 2834 OLD FAIR RD GRAND ISLAND NE 68803 Tax Program Tax Period Date of Assessment Tax Penalty Interest Costs Total Due Sales 08/01/2019 - 08/31/2019 10/01/2019 .00 .00 1.04 .00 1.04 Sales 09101/2019 - 09/30/2019 12/02/2019 .00 .00 2.10 .00 2.10 Sales 11/01/2019 - 11/30/2019 03/02/2020 .00 .00 10.18 .00 10.18 Sales 12/0I/2019-03/31/2020 07/05/2020 4,380.98 1,244.00 270.59 .00 5,895.57 Sales 04/01/2020 - 04/30/2020 06/01/2020 .00 .00 .85 .00 .85 Sales 05/01/2020-05/312020 07/01/2020 .00 83.44 .53 .00 83.97 Sales 08/01/2020 - 08%312020 11/02/2020 .00 .00 .00 100.00 100.00 Sales 11/01/2020- 11/30/2020 02/01/2021 .00 .00 .00 100.00 100.00 Waste Reduction 07/01 /2018 - 06/30/2019 09/23/2019 25.00 .00 1.66 .00 26.66 Waste Reduction 07/01/2019 - 06/30/2020 12/14/2020 25.00 5.00 .29 .00 30.29 Withholding 01/01/2020 - 03/31/2020 06/24/2020 .00 13.15 .97 .00 14.12 Total 6,264.78 sign here I certify that the Nebraska Department of Revenue has compiled with the laws of the Stale of Nebraska in determining the amount shown lobe due, and that the taxpayer has laded to pay the amount due after demand. This Notice of State Tax Lien a an ellecliw lion and serves to continue the priority of the State's interest fn thea property of the taxpayer. Authorized Revenue Agent rue Revenue Senior Agent Title 02/04/2021 402-471-6067 Date Phone Number 2//2/202/ Data 4-494.1874 tem 64018 Supersedes 4-e4-1974 Rev. 8-7013